Inhalation treatment: Errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children

Abstract

The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurrence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.

Metered dose inhaler-spacer use education effects on achieve asthma control in children

“…Many research have shown that a high proportion of children do mistakes while using inhaled treatments (10,13,23). Lack of cooperation in young children especially hand mouth coordination may interfere with effective inhalation therapy with MDI (13,24,25). It has been demonstrated that the most common mistakes include not exhaling before starting, not shaking the MDI and inhaling for a very short time (10,13,21,(23)(24)(25)(26)(27).…”

“…Lack of cooperation in young children especially hand mouth coordination may interfere with effective inhalation therapy with MDI (13,24,25). It has been demonstrated that the most common mistakes include not exhaling before starting, not shaking the MDI and inhaling for a very short time (10,13,21,(23)(24)(25)(26)(27). Similar with other studies, common mistakes detected in our study were lack of mouth rinsing after use followed by lack of exhalation before inhaling the drug and not shaking the inhaler before use.…”

“…Also repeated education is required for correct inhaler technique., due to inhaler technique may worsen after initial tutorial (9,25,28). HCP should repeat this instructions at subsequent visits to confirm correct usage of inhaler device (29,30).…”

“…It has been reported that most children and adults reduce their mistakes in inhalation device use after getting education about it (31,32). Repeated educations result in better inhalation technique and play a key role in successful inhalation therapy (8,9,22,23,25,30,31). It is reported that repeated education about MDI inhalation technique resulted in a statistically significant improvement in MDI technique scores when compared to single education (33,34).…”

“…Inappropriate inhalation technique decreases drug delivery in the lungs and decreases the efficacy of medical treatment and hinder better asthma control (7,8,10,11). People with asthma and improper inhaler technique were shown to have poorer symptom control compared to those with good inhaler technique, with a subsequent increase in medical or emergency visits (8,11,20,25). Furthermore, as improved inhalation technique has been shown to improve adherence to asthma therapy (possibly due to the positive reinforcing effects of improved symptom relief concurrent with improved medication administration (29).…”