Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations.
OBJECTIVE
To determine the ability of children and adolescents with acute asthma exacerbations to adhere to national guidelines for proper metered-dose inhaler (MDI) and peak flow meter (PFM) technique and to define characteristics associated with improper use.


METHODS
A prospective study in which the patients were instructed to use a placebo MDI or a PFM in the emergency department exactly as at home. Technique was graded on the basis of performance of specific steps recommended by national guidelines.


METHODS
Children and adolescents (aged 2-18 years) with acute asthma exacerbations in the emergency department of an urban children's hospital with acute asthma.


RESULTS
Thirty-three (45.2%) of 73 patients using an MDI (MDI group) demonstrated multiple steps improperly compared with 60 (44.4%) of 135 using an MDI with a holding chamber (MDI-HC group; P =.92). In the MDI group, young ages of the patients (P<.008) and the parents (P<.003) were associated with improper use. In the MDI-HC group, factors independently and significantly associated with improper use were no hospitalizations within the past year, parent assistance of the patient with MDI-HC use, and nondaily use of the MDI-HC. Also, 165 (82.9%) of 199 children who, per national guidelines, should be using a PFM at home, did not. Eighty-two (73.9%) of 111 patients demonstrated perfect performance of all PFM steps.


CONCLUSIONS
Among children with acute asthma, we found high rates of improper MDI use and PFM underuse. A greater emphasis must be placed on teaching methods to optimize drug delivery and to instruct patients about the importance of self-monitoring of disease severity.
Scarfone
Richard J
RJ
Department of Pedeatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Capraro
Geoffrey A
GA
Zorc
Joseph J
JJ
Zhao
Huaqing
H
D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D016015:Logistic Models; D008297:Male; D009330:Nebulizers and Vaporizers; D016017:Odds Ratio; D010353:Patient Education as Topic; D011446:Prospective Studies; D012307:Risk Factors
D018927:Anti-Asthmatic Agents