Many Caregivers Unable to Demonstrate Proper Use of Kids' Asthma Inhalers

All but a handful of adults who care for children with asthma failed to properly demonstrate the essential steps in the use of a metered-dose inhaler, according to a recently published study.

A new study finds that an overwhelming majority of adults who care for children with persistent asthma could not demonstrate how to properly use a metered-dose inhaler with a spacer device, even though most said a doctor or nurse had previously instructed them on its use.

The cross-sectional study, published online on October 21, 2013, in the Journal of Asthma, aimed to determine whether caregivers use proper technique when assisting children with metered-dose inhalers with spacer devices in the New York City borough of the Bronx, where many low-income and minority children suffer from persistent asthma. The researchers used data collected in a community-based trial of 169 caregivers of children aged 2 to 9 who had asthma diagnosed by a physician, a current prescription for an inhaled corticosteroid, and who had experienced an asthma exacerbation in the past year that required hospitalization or a visit to an emergency department or clinic. Based on information provided by the caregivers, the children were classified as having well-controlled, not well-controlled, or very poorly controlled asthma.

To evaluate metered-dose inhaler technique, the researchers identified 10 steps needed for accurate use, based on manufacturer instructions and guidelines from the National Heart, Lung, and Blood Institute. Of these steps, 5 were deemed essential for adequate medication delivery using the device. Caregivers participating in the study were asked to describe how to administer medication using the metered-dose inhaler with a spacer device and were then asked to demonstrate its use on a doll that represented their child. Caregivers who correctly completed 7 or more of the 10 steps were considered to be correct users while those who completed 6 steps or fewer were determined to be incorrect users.

Overall, 87% of children in the study had not well or very poorly controlled asthma, and 71% used a spacer device with their inhaler all or most of the time. Among the caregivers, only 1 (0.6%) correctly demonstrated all 10 steps, and only 6 (3.6%) demonstrated all 5 essential techniques. These results were particularly disappointing given that 92.9% of the caregivers indicated that a doctor or nurse had explained how to use the inhaler and spacer, and 85.2% said a doctor or nurse had shown them how to use the device. However, only 53.8% reported that the doctor or nurse asked them to demonstrate that they understood how to use the device.

The results also indicated that having an asthma-related hospitalization in the past year and higher caregiver educational level were significantly associated with correct inhaler and spacer use. Correct use of the device was most likely re-taught during hospitalization and discharge by physicians, nurses, pharmacists, and respiratory therapists, the authors of the study suggest.

When inhalers and spacers are used incorrectly, patients may receive less medication than they should, which can lead to poor outcomes. Therefore, the authors suggest that improving understanding of correct inhaler technique among caregivers may help improve outcomes in children with persistent asthma.

“Targeted educational interventions for both caregivers and healthcare providers coupled with regular evaluation of caregiver inhalation technique are needed to optimize medication delivery in children with persistent asthma,” they write.