title: Are children with asthma overconfident that they are using their inhalers correctly?
abstract: OBJECTIVE
  The objectives of this study were to quantify the extent to which children with asthma are overconfident that they are using their inhalers correctly and determine whether demographic and clinical characteristics are associated with children being overconfident.
  
  
  METHODS
  Children (n = 91) ages 7-17 with persistent asthma were recruited at two pediatric practices in North Carolina and demonstrated their inhaler technique for metered dose inhalers during an office visit. Children were dichotomized into two groups based on how confident they were that they were using their inhalers correctly: "completely confident" or "not completely confident". The mean number of inhaler steps (out of 8) children performed incorrectly was examined. We applied linear regression models for children in the "completely confident" group to determine whether demographic and clinical factors predicted their overconfidence, defined as the number of inhaler steps performed incorrectly.
  
  
  RESULTS
  Children were primarily male (56%) and non-Hispanic White (60%). Sixty-eight (75%) children were "completely confident" that they were using their inhalers correctly. The "completely confident" group missed an average of 1.5 steps. In the "completely confident" group, males (p < 0.04) missed significantly more steps than females. The two most common errors were forgetting to shake the inhaler and holding their breath for 10 s.
  
  
  CONCLUSIONS
  Regardless of their confidence level, children in our sample missed an average of 1-2 steps on an inhaler technique assessment. Findings from this study provide new evidence that it is insufficient to ask children if they are using their inhalers correctly. Therefore, it is vital that providers ask children to demonstrate their inhaler technique during health encounters.
authors.affiliation: a Eshelman School of Pharmacy, University of North Carolina , Asheville , NC , USA .
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Alexander
authors.affiliation: a Eshelman School of Pharmacy, University of North Carolina , Asheville , NC , USA .
authors.forename: Lorie
authors.initials: L
authors.lastname: Geryk
authors.affiliation: b Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA .
authors.forename: Courtney
authors.initials: C
authors.lastname: Arrindell
authors.affiliation: c School of Medicine, University of North Carolina , Chapel Hill , NC , USA , and.
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.affiliation: d Departments of Medicine and Biostatistics , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: a Eshelman School of Pharmacy, University of North Carolina , Asheville , NC , USA .
authors.forename: Betsy
authors.initials: B
authors.lastname: Sleath
authors.affiliation: a Eshelman School of Pharmacy, University of North Carolina , Asheville , NC , USA .
authors.forename: Delesha M
authors.initials: DM
authors.lastname: Carpenter
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000188:drug therapy / Q000523:psychology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D020377:Self Efficacy
keywords: Asthma; asthma control; children; inhaler technique; self-efficacy