Inhalation Therapy for Airway Humidification in Children – A Controversial Treatment
- Johanna
- Feb 17
- 5 min read
Updated: Mar 9
The airways of your child play a central role in defending against infections and irritants. Especially during colds, many parents turn to inhalation therapies, to moisten the mucous membranes and loosen mucus. In the following, you will learn what science has to say on the subject, the various methods available, and practical tips for proper use.
1. Basics of Inhalation
In inhalation therapy, a fine mist—consisting of saline solution and/or medications—is delivered into the airways. The advantage is that the active ingredient reaches the lungs directly, bypassing the bloodstream.
2. Controversy Over Airway Humidification
The use of inhalation therapy to humidify the airways in children with colds (without severe or chronic respiratory diseases) is seen as controversial treatment. Some doctors support this method and prescribe inhalers, while others recommend only medicinal therapies using inhalation devices. What does your pediatrician think?
Current Situation:
Lack of conclusive studies on the effectiveness of airway humidification.
Several studies indicate that inhalation for airway humidification only provides a short-term, subjective alleviation of symptoms—without significantly altering the course of the illness.
A 2017 Cochrane Review concluded that inhaling for airway humidification brings neither clear advantages nor serious disadvantages.
Scientific findings on this topic are not yet conclusive, and further evidence is needed.
Research in cystic fibrosis shows that inhaling saline solutions with higher concentrations of NaCl (3%-7%) can loosen thick mucus in the airways, improve lung function, and reduce acute deteriorations. Reviews also confirm that this therapy supports the natural cleaning of the airways.
A significant problem, which is why many doctors today refrain from prescribing conventional inhalers, lies in the difficult hygiene of cleaning the devices. The formerly widespread compressor inhalers consist of numerous individual parts and hoses, making thorough cleaning challenging. If this step is not carried out meticulously, germs can accumulate, ultimately leading to illnesses.
The current evidence does not show clear advantages or significant disadvantages of inhalation therapy for humidifying the airways during colds. Therefore, it is difficult to give an unequivocal recommendation for or against this therapy. If you decide to use inhalation therapy, be sure to follow the manufacturer's instructions, hygiene guidelines, and cleaning recommendations.
3. Types of Inhalation
There are several methods to create a fine mist, each with its own pros and cons:
Nebulizers: Saline solution or medications are aerosolized into a fine mist that reaches deep into the lungs. This method is especially effective for treating the lower airways.
Steam Inhalation: Hot water vapor is inhaled, mainly reaching the upper airways. However, this technique carries the risk of burns and mucous membrane irritation. Steam inhalation is not suitable for children!
Metered-Dose Inhalers with Spacers: Particularly used for medicinal therapies (e.g., in asthma or pneumonia), these devices help transport the active ingredient optimally into the lungs.
Recommendation: Ultrasound Nebulizers
These devices create extremely fine water droplets that penetrate deep into the airways and help loosen stubborn mucus. Due to their ease of use and better reach, they are the preferred method. They can be expensive, sometimes deals are available.
Advantages:
Nearly silent operation
Energy-efficient
Easy to clean
Gentle medication processing
Compact and handy
4. Inhalation Solutions
A common component of inhalation therapy is saline solution. The main types are:
Isotonic Saline (0.9% NaCl): This is the standard inhalation solution. It has the same salt concentration as blood plasma and primarily serves to moisten the airways and assist in mucus clearance.
Hypertonic Saline (≥ 3% NaCl): This solution can help to loosen stubborn mucus—a benefit supported by studies. However, its higher salt concentration carries the risk of further irritating the airways and triggering increased coughing during inhalation. If you are unable to clear your child’s mucus using adequate fluid intake and 0.9% NaCl inhalations, please consult your pediatrician before switching to the 3% solution.
Medications: Under a doctor’s prescription, active ingredients such as salbutamol, corticosteroids, etc., may also be used.
Avoid Essential Oils! Strong essential oils like menthol, camphor, or eucalyptus can cause the vocal cords to spasm and may trigger acute respiratory distress. In such cases, call emergency services immediately.
5. Alternatives to Classical Inhalation
In addition to inhalation therapy, there are other supportive measures:
Adequate Fluid Intake: Drinking plenty helps to thin the mucus and hydrate the body from within.
Increase Room Humidity: Regular ventilation and walks in fresh air are beneficial.
Warm Chest Wraps: A warm chest wrap can have a calming effect, promote circulation, and relax the respiratory muscles.
Honey for Cough Relief: For children over 12 months, honey can reduce coughing frequency—an effect supported by studies. >>> Read more
Nasal Irrigations: Sterile nasal rinses from the pharmacy offer a simple and hygienic method for cleaning the nasal passages.
Mucolytics/Cough Syrups Not Recommended: These are not recommended for children due to a lack of scientific evidence on their effectiveness and the potential for side effects.
6. Hygiene and Application – Practical Tips
The success of inhalation therapy largely depends on correct usage:
Observe Your Child Carefully: Watch for changes in overall condition, fever, pain, or altered breathing. In such cases, it is essential to consult a doctor.
Age-Appropriate Devices: Even infants can use an inhalation device. Special masks are available for babies and toddlers up to about 2 years old. From about 3 years of age, children can alternatively use a mouthpiece, which is often more effective since the mist reaches the airways better. It is important that the mask or mouthpiece fits properly.
Proper Posture: An upright sitting position is ideal. Depending on age, the child may sit on a parent’s lap or stand in front of the inhalation device.
Practice and Distraction: Practice inhaling with stuffed animals or favorite dolls first, and distract the child during the procedure with stories or reading.
Use NaCl Ampoules from the Pharmacy: These are hygienically safe.
Medications (e.g., Salbutamol or Corticosteroids): Only use these under a doctor’s prescription.
Cleaning: Nebulizers, masks, and hoses must be thoroughly cleaned and—if recommended—disinfected after each use, according to the manufacturer’s instructions, to minimize the risk of germ transmission.
7. Conclusion
Your child’s airways are crucial for protecting against infections. Inhalation therapies can moisten the mucous membranes and loosen stubborn mucus. It is important to emphasize that the effectiveness of these therapies is not sufficiently supported by scientific evidence. Therefore, their use should always be in consultation with your pediatrician, and additional measures such as adequate fluid intake and fresh air should be implemented.
Note: This guide does not replace medical advice. Always discuss inhalation therapies with your pediatrician, especially if your child shows additional symptoms or if their overall condition deteriorates.
Stand: 03/2025
Resources:
Elkins, M. R., Robinson, M., Moriarty, C., et al. (2006): A controlled trial of long‐term inhaled hypertonic saline in patients with cystic fibrosis. New England Journal of Medicine.
Jiang, M. (2015): Airway Humidification Reduces the Inflammatory Response During Mechanical Ventilation. Respiratory Care.
Marseglia, A., et al. (2021): Acute cough in children and adolescents: A systematic review and a practical algorithm by the Italian Society of Pediatric Allergy and Immunology. Allergologia et Immunopathologia.
Pekcan, A. (2012): Inhaled Therapy in Children.
Pörksen, S. (2014): Inhalationstherapie bei Atemwegserkrankungen im Kindesalter. Monatsschrift Kinderheilkunde.
Safina, S. (2024): Acute cough in young children in the practice of a primary care pediatrician. Meditsinskiy sovet = Medical Council.
Singh, et al. (2017): Erhitzte, befeuchtete Luft bei Erkältung. Cochrane Review.https://www.cochrane.org/de/CD001728/ARI_erhitzte-befeuchtete-luft-bei-erkaltung
Sriabina, et al. (2020): The efficacy and tolerability of inhaled hypertonic saline in children with cystic fibrosis. European Respiratory Journal.
Stahl, M., 2019: Preventive Inhalation of Hypertonic Saline in Infants with Cystic Fibrosis (PRESIS). A Randomized, Double-Blind, Controlled Study. https://pubmed.ncbi.nlm.nih.gov/30409023/
Wark, P. A., McDonald, V., et al. (2018): Nebulised hypertonic saline for cystic fibrosis. Cochrane Database of Systematic Reviews.
Zhang, et al. (2017): Ist die Verabreichung von hypertoner Kochsalzlösung über einen Vernebler bei Kleinkindern mit akuter Bronchiolitis wirksam und sicher?https://www.cochrane.org/de/CD006458/ARI_ist-die-verabreichung-von-hypertoner-kochsalzlosung-uber-einen-vernebler-bei-kleinkindern-mit-akuter
