Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Little is known about the extent to which providers model proper use of asthma devices to children or the extent to which providers have the children demonstrate how they use their devices during medical visits. WHAT THIS STUDY ADDS:The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.abstract OBJECTIVE: The purposes of this study were to (a) describe the extent to which children use metered dose inhalers, turbuhalers, diskuses, and peak flow meters correctly, and (b) investigate how often providers assess and demonstrate use of metered dose inhalers, turbuinhalers, diskuses, and peak flow meters during pediatric asthma visits. PATIENTS AND METHODS:Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All of the medical visits were audiotape-recorded. Children were interviewed after their medical visits, and their device technique was observed and rated by the research assistants. RESULTS:Of the patients, 296 had useable audiotape data. Only 8.1% of children performed all of the metered dose inhaler steps correctly. Older children were more likely to get more of the metered dose inhaler steps correct. Of the children, 22% performed all of the diskus steps correctly, 15.6% performed all of the turbuhaler steps correctly, and 24% performed all of the peak flow meter steps correctly. The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.

A Randomized Comparison between Video Demonstration and Verbal Instruction in Improving Rota Haler Technique in Children with Persistent Asthma: A Pilot Study

“…In our study, also we find that 14.28% used the rota haler device correctly in the oral instruction group at immediate assessment which is comparable to the study by Sleath B et al, [7]. However, 57.14% in the video demonstration group performed all the steps correctly.…”

“…In a study by Sleath B et al, looking at the proportion of children using their devices correctly, it was seen that only 8.1% performed all the steps correctly for MDIs, 22% for discus and 15.6% for turbu haler [7]. In our study, also we find that 14.28% used the rota haler device correctly in the oral instruction group at immediate assessment which is comparable to the study by Sleath B et al, [7].…”

“…Factors important in patient compliance with therapy include correct use of device, ease and convenience of use of the device and adopting a proper technique while using them [4]. Many children with asthma do not use their inhalational devices correctly and need some kind of education to improve their use [3,[5][6][7]. Though several studies regarding techniques and demonstrations to help patients use inhaler devices in an effective way have been carried out, the role of video aided demonstrations in improving rota haler technique has not yet been studied convincingly.…”

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

“…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.…”

Checklists for Powder Inhaler Technique: A Review and Recommendations

“…18 33 reported the proportion of patients with any critical errors. Some authors also reported data for each individual checklist step, reporting the proportion of patients performing each step correctly 43 or incorrectly. 33 …”