University of Oulu

Csonka, P., Tapiainen, T., Mäkelä, M.J. et al. Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature. Eur J Pediatr 180, 3101–3109 (2021).

Optimal administration of bronchodilators with valved holding chambers in preschool children : a review of literature

Saved in:
Author: Csonka, Péter1,2; Tapiainen, Terhi3; Mäkelä, Mika J.4;
Organizations: 1Centre for Child Health Research, Tampere University and Tampere University Hospital, Kalevantie 4, 33014 Tampereen yliopisto, Tampere, Finland
2Terveystalo Healthcare, Tampere, Finland
3Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and PEDEGO Research Unit, University of Oulu, Oulu, Finland
4Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
5Allergy Centre, Tampere University Hospital, Tampere, Finland
6Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: Springer Nature, 2021
Publish Date: 2021-10-13


Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment.

see all

Series: European journal of pediatrics
ISSN: 0340-6199
ISSN-E: 1432-1076
ISSN-L: 0340-6199
Volume: 180
Issue: 10
Pages: 3101 - 3109
DOI: 10.1007/s00431-021-04074-3
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3123 Gynaecology and paediatrics
3121 General medicine, internal medicine and other clinical medicine
Funding: This study was supported by the Tampere Tuberculosis Foundation and the Research Foundation of the Pulmonary Disease.
Copyright information: © The Author(s) 2021. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit