title: Incentive device improves spacer technique but not clinical outcome in preschool children with asthma.
abstract: OBJECTIVE
  To investigate the influence of an incentive device, the Funhaler, on spacer technique and symptom control in young children with asthma and recurrent wheeze.
  
  
  METHODS
  Randomised controlled trial where 132 2-6 year old asthmatic children received regular inhaled fluticasone through Aerochamber Plus, or Funhaler. The setting was a research clinic at Princess Margaret Hospital for Children, Perth, Australia. Subjects were followed up for a year. The main outcome measure was asthma symptoms. Proficiency in spacer technique was measured as salbutamol inhaled from spacer onto filter. Quality of life was measured every three months. Groups were compared in terms of spacer technique, symptoms and quality of life. The relationship between spacer technique and clinical outcome was examined.
  
  
  RESULTS
  There was no difference between Funhaler and Aerochamber groups in wheeze free days, cough free days, bronchodilator free days or quality of life (P = 0.90, 0.87, 0.74 and 0.11 respectively). Spacer technique was better in the Funhaler group (P = 0.05), particularly in subjects younger than 4 years of age (P = 0.002). Drug dose on filter (as the mean of five 100 mg doses) ranged from zero to 136 mg.
  
  
  CONCLUSIONS
  Use of Funhaler incentive device does not improve clinical outcome, but improves spacer technique in children younger than 4 years. Variability in drug delivery is large in young children using pressurised metered dose inhalers and spacers.
authors: School of Paediatrics and Child Health, University of Western, Perth, Western Australia, Australia. andre.schultz@health.wa.gov.au
authors: André
authors: A
authors: Schultz
authors: Peter D
authors: PD
authors: Sly
authors: Guicheng
authors: G
authors: Zhang
authors: André
authors: A
authors: Venter
authors: Peter N
authors: PN
authors: Le Souëf
authors: Sunalene G
authors: SG
authors: Devadason
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000730:Androstadienes / Q000008:administration & dosage; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005246:Feedback; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D017063:Outcome Assessment, Health Care / Q000379:methods*; D014904:Western Australia
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone