Evaluation of inhaler use technique in a pediatric appointment

Abstract

Introduction: Inhalers are recommended for asthma prophylactic and crisis therapy. In order to have a good deposition of drugs at pulmonary tissue, the correct use of the devices is necessary. Objective: To verify the inhaler use technique with pressurized metered-dose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs) in a pediatric sample (ages between 1 and 17 years old). Material and Methods: Descriptive, observational and cross-sectional study. Application of a checklist that included the steps of the correct inhaler use technique, which was performed under physician observation, and other questions related to the use of the devices. Results: We observed a total of 83 inhaler use techniques: 46 pMDIs with spacers and 37 DPIs. About 54% of pMDIs with spacers users and 27% of DPIs users performed the inhaler use technique correctly, p=0.012. The most frequent mistakes in pMDIs with spacers users were: 50% didn’t waste the first puff, 17.4% didn’t shake the device prior to use and 28.3% didn’t wait between inhalations. The mistakes observed in DPIs users were: 43.2% didn’t perform a forced expiration before inhaler use, 13.5% didn’t start with a forced inspiration, 24.3% didn’t pause at the end of inspiration, 32.4% didn’t exhale slowly and 35.1% didn ́t wait between inhalations. Conclusion: Multiple mistakes were observed even in the users who had been followed up for several years. The most frequent mistakes occurred in DPIs users. Thus, the inhaler use technique must always be observed by the physician in all appointments, especially in users of DPIs in which the correct use depends on their autonomy. Introduction Asthma is the most common chronic disease of childhood and is characterized by a chronic airway inflammation.1 It’s a global health problem and its prevalence is increasing.1 Treatment goals are to achieve symptoms control, maintain normal activity levels and minimize risk of exacerbations or sequelae.1 Inhalation is the recommended route for both exacerbations and prophylactic therapy.1,2 There is a wide variety of devices available on the market with different inhaler use technique.3 The selection of the right inhaler must take into consideration the age of the child, inspiratory capacity and collaborative ability.1,4 It is very important that inhaled particles deposit in the lungs, and the only way to achieve it is with a correct inhaler use technique.5 The correct use of devices is associated with the control of asthma.2,4,6 The incorrect use is associated with exacerbations, more use of systemic corticosteroids, more visits to the hospital, absences from school, reduction and limitation of sports activities.5 The aims of this study were to characterize and verify the inhaler use technique with pressurized metereddose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs). Methods & Materials Descriptive, observational and cross-sectional study. We included all children (between 1 and 17 years old) who used inhaled therapy and were followed up in a pediatric appointment of our hospital, after their caregivers’ consent. The duration period of the study was 2 months (October and November 2018). We observed the inhaler use technique using sample devices during pediatric consultation. We used a checklist, literature-based>sup>3,4, to verify if all steps were correctly performed. To define a correct technique, we considered all the steps listed in table 1 and 3, except the waste of the first puff in pMDIs. Afterwards we made additional questions to the child and caregiver about issues related to the use of pMDIs with spacers and DPIs. The statistical analysis performed, using SPSS 22®, was descriptive and bivariate, we used Chi-square and Fisher’s exact test (α = 0.05). Address for Correspondance: Joana Cleto Duarte da Costa Ribeiro, Rua da Figueira, no38, Ericeira. 2655431 Ericeira. Portugal. Email: joana-ribeiro@campus.ul.pt ©2021 Pediatric Oncall ARTICLE HISTORY Received 30 September 2021 Accepted 29 November 2021