Asthma patients continue to abuse inhaler therapy despite recommendations

A new study shows that while parents and children have confidence in the proper use of asthma inhalers, most of them have misused their devices when they have been put into practice.

Senior researcher Anna Volerman, MD, badistant professor of medicine at the University of Chicago's School of Medicine, said MD Magazine® As a pediatrician, some of his patients would tell him that they were uncomfortable with the use of an inhaler.

"Often, they missed important milestones, which prevented the drug from reaching their lungs," she said.

Research has shown that few asthmatic children use their inhalers properly. However, the National Education and Asthma Prevention Program guidelines explicitly state that each visit to a health care provider must include a review of the inhalation technique and the procedure. use of devices.

Volerman and colleagues said that providers will usually interview patients about their techniques and that if the patient seems confident they will not investigate further. This is particularly due to lack of time, limited staff training or lack of demonstration training supplies.

Investigators conducted an observational study over a one-year period, between 2016 and 2017, in four Chicago charter schools. The student population was 97% African-Americans and 82% low-income. Of the 189 children eligible for study, 65 (34.4%) were enrolled.

The children independently badessed their comfort using a metered dose inhaler on a four-point Likert scale. Parents completed questionnaires about their confidence in their child's ability to properly use the inhaler on a 10-point Likert scale. The children then illustrated their skills using a metered-dose inhaler, their technique being evaluated with the help of a 12-step checklist.

Seventy-one percent of children and 92% of parents reported having confidence in proper use by inhaler (for children, this included self-reporting of independent use). The children performed an average of 3.65 steps on the inhalation technique. With the exception of only one child, all used their inhalers incorrectly.

Volerman said the processes should be both developed and supported to ensure that children and parents are informed about the effective use of inhalers at every health facility encounter.

"This type of education has improved outcomes for the health of children with asthma, but it is limited because of the time and resources required," said Volerman. "But giving a family a sheet of paper with instructions is not enough. They need practical instruction that allows people to see how that works and to demonstrate it themselves. "

Notable limitations include the small size of the sample, the technique relegated to MDIs, and participants with possibly social desirability bias.

Volerman noted that investigators needed to confirm whether these results could be replicated in children of different ages, races, ethnicities, and even in urban and rural areas.

"Studies should also focus on the development and evaluation of technology-based interventions to support consistent, high-quality education on the use of inhalers by children and those who use them." take care, "she said.

L & # 39; study "Is the inhalation technique the confidence of African American children and their parents?", was published online in the Annals of Allergy, Asthma and Immunology.