About 7 million children in the United States suffer from asthma, and most are typically dependent on caregivers to administer their medications, often via metered-dose inhalers (MDIs). To ensure that the appropriate dose is inhaled, a spacer is commonly used. “The spacer device is generally prescribed for kids with asthma in the U.S., but incorrect use can result in decreased drug delivery to distal airways and poor asthma outcomes,” says Marina Reznik, MD, MS.
Caregiver Technique for Pediatric Asthma
Few studies have examined whether caregivers of young minority children with persistent asthma use the proper technique when applying an MDI-spacer delivery system. To address this void, Dr. Reznik and colleagues had a study published in the Journal of Asthma that surveyed and evaluated 169 caregivers of urban minority children with persistent asthma who were prescribed daily medication with MDIs. The researchers monitored the administering technique among caregivers using a 10-step checklist that outlined guideline recommendations on appropriate methods for delivering adequate medication. Five of the 10 steps were deemed essential for adequate delivery of asthma medication.
The majority of caregivers who administered daily asthma medication used the incorrect MDI-spacer technique, according to Dr. Reznik. “Only one of 169 caregivers accurately carried out all 10 steps outlined in national guidelines as the appropriate method to deliver adequate medication. Fewer than 4% of study subjects were able to complete five essential steps.” Caregivers whose children had been admitted for asthma in the past year were more likely to exhibit correct use, suggesting that they were retrained during the hospitalization. Higher caregiver educational level also correlated with proper use of the MDI-spacer technique.
“Caregivers need regular demonstration and evaluation of the correct technique to help improve clinical outcomes.”
Caregivers were also asked about how well the child’s asthma was controlled and if they had been instructed by a medical professional on how to administer asthma medication properly. More than 90% of caregivers reported receiving a verbal explanation on how to administer asthma medication, but only 54% were asked to demonstrate that they could actually do it themselves.
Important Implications on Asthma Outcomes
The goal of using daily asthma medication is to control underlying airway inflammation, thereby reducing asthma symptoms and preventing attacks. Dr. Reznik says targeted short- and long-term educational interventions may be beneficial. “Caregivers need regular demonstration and evaluation of the correct technique to help improve clinical outcomes, especially in areas where rates of asthma are high, and low-income minority children are largely affected. Education is critical to maximizing our ability to keep children with asthma healthy.”
Readings & Resources (click to view)
Reznik M, Silver EJ, Cao Y. Evaluation of MDI-spacer utilization and technique in caregivers of urban minority children with persistent asthma. J Asthma. 2013 Oct 22 [Epub ahead of print]. Available at: http://informahealthcare.com/doi/abs/10.3109/02770903.2013.854379. Reznik M, Hailpern SM, Ozuah PO. Predictors of early hospital readmission for asthma among inner-city children. J Asthma. 2006;43:37-40. Chan DS, Callahan CW, Hatch-Pigott VB, et al. Concurrent use of metered-dose and dry powder inhalers by children with persistent asthma does not adversely affect spacer/inhaler technique. Ann Pharmacother. 2006;40:1743-1746. Aziz NA, Norzila MZ, Hamid MZ, Noorlaili MT. Skills amongst parents of children with asthma: a pilot interventional study in primary care setting. Med J Malaysia. 2006;61:534-539. Newman KB, Milne S, Hamilton C, Hall K. A comparison of albuterol administered by metered-dose inhaler and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma. Chest. 2002;121:1036-1041. Scarfone RJ, Capraro GA, Zorc JJ, Zhao H. Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations. Arch Pediatr Adolesc Med. 2002;156:378-383.