An intervention to improve the inhalatory technique of children and adolescents with asthma.
BACKGROUND
most patients use their inhalers incorrectly and recent asthma management clinical guidelines recommend demonstrating skills and correcting performance at each asthma follow-up visit. However, this statement is poorly evidence-based and few intervention studies have assessed quantitatively the effectiveness of this recommendation.


METHODS
from a total of 3,076 children and adolescents with asthma attending an outpatient clinic, a random, representative sample of 255 was obtained and assessed at baseline with a standardised questionnaire regarding their skills when using one of three inhaler devices: pressurised direct aerosol (PDA), dry powder (DP) and aerosol pressurised in expanded camera (APEC). Structured sessions of correct use and handling of inhalers were offered and a new assessment was undertaken after an average of 10.5 months (SD 4.5).


RESULTS
only 142 asthmatics maintained the same inhaler device during the study period. An increase of correct manoeuvres was observed for all three devices, and the relative risk and 95% confidence interval (RR and 95% CI) of incorrect post-intervention use was 0.23 (95% CI 0.10-0.56) for PDA, 0.59 (95% CI 0.38-0.92) for DP, and 0.54 (95% CI 0.32-0.90) for APEC. A multivariate analysis indicates that this improvement was observed irrespective of gender and age interval, and that it was even better when parents cooperated with medical and nursing staff.


CONCLUSIONS
a dramatic improvement in correct manoeuvres with any of three inhaler devices after active performance training was observed. This easy, highly effective, low cost (in terms of time and personnel) intervention should be routinely implemented in any control visit of asthmatics, leading to a better management of asthma.
Gracia-Antequera
M
M
Department of Pediatrics, Hospital Universitario Doctor Peset, Valencia, 46017, España.
Morales Suárez-Varela
M
M
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D010353:Patient Education as Topic / Q000379:methods*