Predictors of proper inhaler technique and asthma control in pediatric patients with asthma

Abstract

Background Improper use of asthma inhalers is one of the potential factors of poor asthma control among children. This study aimed to assess the proper handling of asthma inhalers and asthma control in addition to factors influencing them among pediatric patients who self‐administer their inhalers. Methods A cross‐sectional study was conducted in Jordan from February 2019 to February 2020. All eligible pediatric patients with asthma attending outpatient settings were approached. The inhalation technique was assessed according to a standard checklist, and asthma control was assessed using the Asthma Control Test. Results A total of 150 patients were included in this study. A metered dose inhaler (MDI) was the most commonly used inhaler device (89.4%) which was used appropriately by only 13.4% of participants. Whereas, appropriate use of Turbohaler and Diskus was reported by 38.5% and 28.9%, respectively. The higher level of parental knowledge was associated with higher number of correct MDI steps (OR = 1.066; 95% CI = 1.010–1.125; p = .020) and less reported errors in critical steps (OR = 0.949; 95% CI = 0.900–0.999; p = .047). Higher level of both parental education and pediatric average stigma score (less stigmatized) were associated with better asthma control ([OR = 5.181; 95% CI = 1.238–21.677; p = .024], [OR = 2.825; 95% CI = 1.420–5.619; p = .003], respectively). Conclusion Continuous education on appropriate inhaler self‐administration for asthmatic children is highly recommended. Clinical pharmacists play a major role toward improving the administration of inhalers through patient training and counseling.

Pediatri Asistanlarının Astım Tedavisinde Kullanılan İnhaler Tedavi Teknikleri Konusunda Bilgi Düzeylerinin Değerlendirilmesi

“…In the present study, the most frequently made mistakes during inhaler treatment were consistent with the mistakes identified in previous studies involving patients with asthma and their caregivers (8,9,20,21). The strengths of the present study include a very high number of health professionals evaluated in a single center and the use of pre-test and post-test evaluations before and after face-toface inhaler technique training.…”

“…A checklist was prepared to assess the use of MDI and DPI (turbuhaler and diskus) devices, which are often used in the treatment of childhood asthma. It comprised the mandatory steps mentioned in the literature and was modified in accordance with our clinical experience (9)(10)(11)(12).…”

“…Each inhaler device has its unique usage technique, advantages, and disadvantages. This should be taken into account when choosing the appropriate device for the patient (7)(8)(9). The fact that health professionals who provide education to patients and their families teach inhaler devices and application steps clearly and accurately plays a key role in the treatment of asthma.…”

Stigma from medication use: an under recognised burden of care

“…Stigma from medication use: an under recognised burden of care Almomani et al [25] looked at stigma in children with asthma and concluded that children who were less stigmatised had a better asthma control. The tool used to look at stigma was modified to ask questions about the embarrassment that asthma patients tend to feel about 1) telling people that they have asthma; and 2) using the inhalers in front of friends or relatives.…”

Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore

“…Daily controller therapy with inhaled corticosteroids (ICS) can reduce chronic airway inflammation, control asthma symptoms and prevent acute exacerbations (2), yet prevalence of uncontrolled asthma remains above 50% in this age group (1). Growing evidence implicates suboptimal adherence to controller inhalers, even when children have symptoms (3)(4)(5), and improper inhaler technique among a majority of children, including lack of awareness of errors among children and their adult caregivers (6)(7)(8)(9)(10). Although global and national asthma guidelines recommend regular assessment of adherence and inhaler technique plus optimization before any step up in therapy (2,11), traditional approaches are insufficient.…”