Children who are hospitalized due to their asthma represent an at-risk population for asthma-related morbidity, including lost days of school, inability to sleep, and lower quality of life, explains Waheeda Samady, MD, MSCI. “They are also at the highest risk of dying from asthma-related complications,” she adds. Evaluating a patient’s inhaler technique can be used to measure how well these children use the medications but studies evaluating inhaler use among hospitalized children with asthma are lacking.

To evaluate inhaler technique in hospitalized pediatric patients with asthma and identify risk factors for improper use, Dr. Samady and colleagues conducted a prospective cross-sectional study in a tertiary children’s hospital for children 2-16 years of age admitted for an asthma exacerbation. “We asked participants to demonstrate how they used their inhaler at home, scoring their performance on an asthma checklist of the necessary steps to take in using an inhaler,” she adds. “We were surprised to find that parents were missing critical steps in getting the medication to the lungs.”

Indeed, among participants (55% with uncontrolled asthma), 42% missed a critical step in inhaler technique. More patients missed a critical step when they used a spacer with mouthpiece versus a spacer with mask (75% vs 36%) and were older (7.8 vs 5.8 years). Patients using the spacer with mouthpiece remained significantly more likely to miss a critical step when adjusting for other clinical covariates.

“Families of children with even long-standing asthma need continuous reinforcement of proper inhaler technique,” says Dr. Samady. “Reinforcement doesn’t just mean explain the steps and think everyone is on the same page; it’s got to be interactive with demonstrations by family and physicians. Inhaler technique should be evaluated at each check-up and continuously improved, especially for adolescents who are starting to be more independent. It’s crucial, because many children with asthma can live full lives if they can get the right meds at the right time.”


Critical Errors in Inhaler Technique among Children Hospitalized with Asthma