Errors in Inhalation Technique and Efficiency in Inhaler Use in Asthmatic Children

Abstract

256 asthmatic children receiving regular inhalation therapy demonstrated how they used their inhalers. Pulmonary function measurements (PFM) were made before and after the demonstrations, and errors in technique were recorded. 242 children had reversible airway obstruction on the day of study. In only 109 (45%) did the inhalation result in an increase in FEV1 greater than or equal to 15% (efficient technique). An efficient inhalation technique was found in 46% of children who demonstrated a pressurized aerosol, 59% who demonstrated a tube spacer aerosol and 46% who demonstrated a rotahaler, and the frequency of efficient technique varied from 17% to 84% between six different groups of instructors. 87% of children controlled and 25% not controlled with PFM at the time of prescription had an efficient technique. Children under 6 years had a more inefficient and a more faulty technique than older children, but otherwise age did not influence the result. Neither was time since instruction of any importance for efficiency or number of errors. The errors recorded that seem to influence efficiency most were: coordination problems, rapid inspirations, ceasing to inspire when the aerosol was fired, and inhalation through the nose. The results emphasize the paramount importance of clear instructions and control of inhalation technique at the time the treatment is prescribed.

The ADMIT series — Issues in Inhalation Therapy. 5) Inhaler selection in children with asthma

“…Most of the difficulties are related to problems with correct coordination of actuation and inhalation -either inhaling too late or too early in relation to the actuation (Table 1). 11,12,26,27 Moreover, cessation of inhalation when the aerosol particles reach the soft palate (the cold Freon effect) or actuation of the aerosol into the mouth followed by inhalation through the nose is common. 11,28 Breath-holding is normally recommended after the inhalation, but the clinical importance of breath-holding has not been documented in children.…”

“…4 In contrast, several studies have demonstrated that large numbers of patients do not use their inhalers correctly and consequently gain little or no therapeutic benefit from the prescribed treatment. [5][6][7][8][9][10][11][12] Therefore, the focus of inhalation therapy should probably be redirected from a main emphasis on in vitro characterisation to assessments of which inhalers are easiest to use correctly by various groups of patients. Due to the heterogeneity of patients no single inhaler will satisfy the needs of all.…”

Incorrect inhaler techniques in Western India: still a common problem

“…1 Incorrect and improper inhaler use is a significant problem for both asthma and COPD management because it may result in diminished therapeutic effect, leading to poor control of symptoms and lacunae in management of these diseases. [8][9][10][11][12] Moreover, the notion of complexity of inhaled therapy may lead to discontinuation of treatment, further impairing the achievement of disease control. 13 In fact, Santus et al found that 18% of patients stopped inhaled therapy spontaneously, mainly due to the complexity of treatment, despite a reported suitable medical explanation.…”

Evaluation of asthma control, parents’ quality of life and preference between AeroChamber Plus and AeroChamber Plus Flow-Vu spacers in young children with asthma

“…Indeed, both children and adults with asthma experience the same problems when using their pMDIs. However, these problems are more pronounced in children, with a greater number of errors seen in those aged under 6 years [10]. Consequently, less than 50% of those children would get the desired therapeutic outcome of their inhaled therapy [3].…”