title: Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations.
abstract: 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.
authors.affiliation: Department of Pedeatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Scarfone
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Capraro
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Zorc
authors.forename: Huaqing
authors.initials: H
authors.lastname: Zhao
mesh_terms: 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
chemical_list: D018927:Anti-Asthmatic Agents