July 1, 2026
Asthma is a chronic inflammatory condition that affects 4.6 million children in the United States[1]. In fact, asthma is the most prevalent chronic illness in children and the primary contributor to childhood morbidity from chronic conditions, as reflected in the number of school absences, emergency department visits, and hospitalizations[2].
According to the 2025 Global Initiative for Asthma (GINA) guidelines, the goals of asthma therapy include:
- Achieving good long-term symptom control, including: few/no asthma symptoms, no sleep disturbance, unimpaired physical activity
- Minimizing future risk of asthma, including: no exacerbations, improved or stable personal best lung function, no requirement for maintenance oral corticosteroids, no medication side effects.
For the most recent GINA Guideline recommendations, visit https://ginasthma.org/reports/.
Encouraging the use of spacers in young children will help ensure proper medication delivery, improve asthma control, and reduce exacerbation risks.
The GINA guidelines recommend the following when choosing an inhaler device for children 5 years old and younger:
Age Group |
Preferred |
Alternative |
Less than 3 years old |
Pressurized metered dose inhaler (MDI) plus dedicated spacer with face mask |
Nebulizer with face mask |
3 to 5 years old The switch from face mask to mouthpiece should be made as soon as the child can demonstrate good technique. |
Pressurized MDI plus dedicated spacer with mouthpiece |
Pressurized MDI plus dedicated spacer with face mask OR nebulizer with face mask or mouthpiece |
Additional Considerations
Educate caregivers on proper spacer technique, emphasizing the importance of slow, deep breaths when using a mouthpiece or a proper seal when using a face mask.
If using a face mask, it should fit tightly around the child's mouth and nose to prevent any medication loss. You can use the following video to give caregivers more information on how an inhaler should be used with a spacer: https://www.youtube.com/watch?v=sQUUJHzO-XQ
Regular follow-ups for assessment of symptom control and medication adjustments as needed (every 3-6 months).
Ensure children are up to date on any recommended vaccinations, including influenza and pneumococcal, to reduce the risk of infections that can exacerbate asthma symptoms.
[1] https://acaai.org/asthma/asthma-101/facts-stats/
[2] Asthma-Related School Absenteeism, Morbidity, and Modifiable Factors - PMC