In the first study to evaluate inhaler technique in children hospitalised for asthma – the group at highest risk for complications and death from asthma – researchers found that nearly half of participants demonstrated improper inhaler use, which means they routinely were not taking in the full dose of medication. Adolescents most commonly displayed critical errors in inhaler technique. They also often skipped using a spacer, which is a device that is recommended for use with an inhaler to help the right amount of asthma medication reach the lungs.
“We know that asthma can be well managed in the majority of patients and using your inhaler correctly is key factor to managing asthma,” says lead author Dr Waheeda Samady, hospitalist at Ann & Robert H Lurie Children‘s Hospital of Chicago, and assistant professor of paediatrics at Northwestern University Feinberg School of Medicine.
“Improper inhaler technique can contribute to children having uncontrolled asthma and needing to come to the hospital for their asthma. Our study suggests that as healthcare providers we can do a better job showing patients and families the correct inhaler and spacer technique, and checking it frequently to ensure they master it.”
Out of 113 study participants, 2-16 years of age, 42% missed at least one critical step in their inhaler technique. Researchers found that 18% did not use a spacer device with their inhaler, and that these patients were mostly older.
“We see that our adolescent patients, who are transitioning to independent medication management, still need close monitoring to make sure they use their inhaler and spacer appropriately to achieve optimal asthma control,” says Samady. “Teens may feel that using a spacer is only for younger children, but using a spacer is recommended for adults as well.”
Previous studies have shown that adding a spacer device to an inhaler increases the amount of asthma medication a person takes in from 34% to 83%.
“Children with asthma can lead full lives if they receive the right medication at the appropriate dose, which is why correct inhaler technique is so crucial,” says Samady.
Past studies have not evaluated inhaler use in hospitalized children with asthma. The objectives of this study were to evaluate inhaler technique in hospitalized pediatric patients with asthma and identify risk factors for improper use. We conducted a prospective cross-sectional study in a tertiary children’s hospital for children 2-16 years of age admitted for an asthma exacerbation, and inhaler technique demonstrations were analyzed. Of 113 participants enrolled, 55% had uncontrolled asthma, and 42% missed a critical step in inhaler technique. More patients missed a critical step when they used a spacer with mouthpiece instead of a spacer with mask (75% [51%-90%] vs 36% [27%-46%]) and were older (7.8 [6.7-8.9] vs 5.8 [5.1-6.5] years). Patients using the spacer with mouthpiece remained significantly more likely to miss a critical step when adjusting for other clinical covariates (odds ratio 6.95 [1.71-28.23], P = .007). Hospital-based education may provide teachable moments to address poor proficiency, especially for older children using a mouthpiece.
Waheeda Samady, Victoria A Rodriguez, Ruchi Gupta, Hannah Palac, Marina Karamanis, Valerie G Press