Withdrawal: “The effect of adding a training device and smartphone application to traditional verbal counseling in asthmatic children” Sara M. Tony, Mona A. Abdelrahman, Hasnaa Osama, Marwa O. Elgendy, Mohamed E. A. Abdelrahim

Abstract

New training devices were introduced to help in the inhaler counseling by addressing the inspiratory flow through the metered-dose inhaler (MDI), which is the most important problem of the MDI inhalation technique. This study aimed to compare the effects of MDI traditional verbal counseling and advanced counseling using training devices with a smartphone application in pediatric asthmatic patients. A total of 201 pediatric asthmatic subjects (8-18 years) were divided into 2 groups: a verbal counseling group, who received only MDI verbal counseling training (n=101), and an advanced counseling group who received counseling using a training device (Flo-Tone with Trainhaler smartphone application) in addition to the traditional MDI verbal counseling (n=100). Every patient in the 2 groups attended three counseling visits, one month apart. At each visit pulmonary functions [peak expiratory flow (PEF), forced expiratory volume in one second (FEV1 ) as % of predicted] were measured. Also, patients were asked to perform their normal inhalation technique using their MDI, and mistakes were detected and recorded by the investigator, then patients were trained on the correct steps of the MDI inhalation technique using either verbal counseling or advanced counseling depending on their study group. In the advanced group, the Flo-Tone was connected to the mouthpiece of the MDI to blow a whistle while the patient inhaling from MDI. That whistle was detected by the Trainhaler smartphone application and the duration of inhalation determined by the application was recorded. Both groups showed a gradual significant decrease (p<0.05) in the total mean number of MDI inhalation techniques mistakes from the second visit of counseling, and the improvement continued in the third visit, with a lower number of mistakes in the advanced group especially in inhaling at a slow rate till lungs are a full step. Also, the advanced counseling group showed a gradual significant increase (p<0.05) in lung functions from the second visit of counseling, while significant improvement (p<0.05) of lung functions was obtained at the third visit in the verbal counseling group. In the advanced group, the number of seconds measured by smartphone application which represents the duration of inhalation increased significantly (p<0.05) in the second and third visits. The addition of training devices and smartphone applications to traditional verbal counseling of MDI inhalation technique in asthmatic children resulted in significant improvements in lung functions, and duration of inhalation, and progressive decreases in the average number of MDI inhalation techniques errors compared to the verbal counseling group.