A cheap, effective spacing device is the cardboard cylinder found inside a roll of toilet paper. With seals between the mouth and the metered aerosol, the roll works quite well. Many commercial spacers are also available-ask a pharmacist to recommend one. For more severe asthmatics and for very young children, solutions of beta-agonists given by nebulization are preferred. Two of the most heavily advertised nonprescription beta-agonists are Primatene Mist and Bronkaid.
Theophyllines are a second important class of bronchodilators used in the treatment of asthma.
Because of their toxicity, however, theophyllines are rarely the first-line treatment in the management of asthma. Theophylline dosage depends on body size, and it must be determined carefully. Even then, there can be significant differences between like-sized individuals, so serum levels should be monitored. Asthma is best viewed as a syndrome of chronic airway inflammation marked by occasional episodes of bronchospasm. Regular use of anti-inflammatory agents therefore should be a part of the treatment plan for any child who has more than very mild, occasional asthma.