Inhaler Technique In Children Research Articles

Mobile video directly observed therapy can be used to improve at-home inhaler technique in children with asthma.

Most children and parents have mobile smartphones that can be used to record videos while the child uses their inhaler. The timed (stamped with date and time) videos can be submitted to a secure repository. An asthma nurse then can review the video. https://bit.ly/2UyG11W

Assessing the impact of a family empowerment program on asthma control and medication use in children with asthma: A randomized controlled trial.

In pediatric asthma, family empowerment education has been beneficial for the quality of life, pulmonary function, and family functioning. Few studies addressed the impact of a family empowerment program on asthma symptom control, acute healthcare use (AHCU), and medication use in children with asthma. This study aimed to assess the effect of a family empowerment intervention on asthma symptom control, AHCU, inhaler technique, and controller adherence in children with asthma. A single-center study using a randomized controlled design was conducted in a university hospital in the center of Tunisia from May 2018 to September 2019. Eighty-two families were randomly assigned to the intervention group (n = 41) of 8 weeks of group training sessions, or to the control group (n = 41) of usual care education. Thirty-seven families in the intervention group and 39 families in the control group received allocated intervention at baseline. Thirty-four families in each group completed the study at the 12-month follow-up. At baseline, the intervention and control groups were statistically comparable (p > .05). At follow-up, there were significant differences between the intervention and the control group in asthma symptom control, χ2 (1, N = 34) = 9.950, p = .002, and inhalation technique, χ2 (1, N = 34) = 5.916, p = .01. For AHCU and adherence to asthma controller, there was no significant difference between groups, χ2 (1, N = 34) = 3.219, p = .07, χ2 (1, N = 34) = 0.541, p = .46, respectively. The difference within time in asthma symptom control and inhalation technique was significant (p = 10-3 , p = .001; respectively). This study demonstrated that a family empowerment program significantly improved asthma symptom control and inhaler technique in children with asthma aged 7-17 years. This intervention could be clinically useful and time-saving for pediatric nurses.

Nebulizer Care and Inhalation Technique in Children with Cystic Fibrosis.

Nebulizers are used by the great majority of cystic fibrosis patients for delivery of cornerstone treatments. Inhalation technique and adequate disinfection and maintenance are important for optimizing medication delivery. In this study, inhalation technique and nebulizer disinfection/maintenance were assessed in cystic fibrosis patients by direct observation in clinic and completion of a scoring sheet. A total of 108 patients were recruited. The maximum inhalation technique score was attained by 30.5% and adequate inhalation technique score by 74.08% of patients. The inhalation technique score was best with the vibrating mesh nebulizer (p = 0.038), while patient age and number of nebulized medications did not affect ITS significantly (p > 0.05). Nebulizer disinfection/maintenance score was excellent in only 31.48%. Most families kept the nebulizer clean and used appropriate disinfection method, but only half of them replaced the nebulizer and nebulizer cup at the recommended time intervals. Nebulizer disinfection/maintenance score was positively affected by a number of nebulized medications and negatively by years of equipment use (p = 0.009 and p = 0.001, respectively). Even though inhalation technique and disinfection/maintenance practices were found to be adequate in a large proportion of cases, there is still a need for regular review and education. The type of nebulizer was associated with improved inhalation technique, but more data are required before making specific recommendations.

How we teach children with asthma to use their inhaler: a scoping review protocol

BackgroundOne reason that asthma remains poorly controlled in children is poor inhaler technique. Current guidelines recommend checking inhaler technique at each clinical visit. However, they do not specify how best to train children to mastery of correct inhaler technique. Currently, many children are simply shown how to use inhalers (brief intervention) which results in less than 50% with correct inhaler technique. The aim of this scoping review is to explore published literature on teaching methods used to train children to master correct inhaler technique.MethodsThis scoping review will follow the Arksey and O’Malley framework and the Joanna Briggs Institute guidelines. We will search (from inception onwards) MEDLINE, Embase, Scopus, Web of Science, CINAHL and the Cochrane library. We will include quantitative studies (e.g. randomised controlled trials, cohort studies and case-control studies), published from the year 1956 to present, on teaching the skill of inhaler technique to children with asthma. Two reviewers will complete all screening and data abstraction independently. Data will be extracted onto a data charting table to create a descriptive summary of the results. Data will then be synthesised with descriptive statistics and visual mapping.DiscussionThis scoping review will provide a broad overview of currently used educational methods to improve inhaler technique in children with asthma. The analysis will allow us to refine future research in this area by focusing on the most effective methods and optimising them.Systematic review registrationOpen Science Framework (osf.io/n7kcw).

What are the effects of interventions to improve inhaler technique in children with asthma?

What are the effects of interventions to improve inhaler technique in children with asthma?

Evaluating Proper Inhaler Technique in Children with Moderate-to-Severe Asthma

Evaluating Proper Inhaler Technique in Children with Moderate-to-Severe Asthma

Using videos to teach children inhaler technique: a pilot randomized controlled trial

Objective: This primary objective of this pilot randomized, controlled trial was to determine whether a brief video intervention delivered after a pediatric office visit could improve inhaler technique in children with asthma immediately and one month later. The intervention’s effect on children’s inhaler self-efficacy and asthma control was also evaluated. Methods: Children (n = 91) ages 7–17 years with persistent asthma were recruited at two pediatric practices in North Carolina. Eligible children demonstrated their inhaler technique for metered dose inhalers (MDIs) either with or without a spacer. A trained research assistant used a validated inhaler technique checklist to record which steps children performed correctly. After a regularly scheduled office visit, children were randomized to watch either a 3-min MDI video (intervention group) or a nutrition video (control group) in English or Spanish. Children’s technique was assessed again after watching the video and one month later. Results: Children were primarily male (56%) and non-White (60%). When compared with the control group, children in the intervention group demonstrated a significant improvement in MDI technique post-intervention [mean = 1.12 steps, 95% CI (0.73, 1.50)] but the improvement was not sustained at 1-month follow-up. The intervention did not lead to significant improvements in inhaler self-efficacy or asthma control. Conclusions: A brief video intervention offered during pediatric clinic visits can lead to immediate improvements in children’s inhaler technique. Future studies should evaluate whether booster training videos can help maintain improvements in children’s inhaler technique over time.

Assessment of Inhalation Technique in Children in General Practice: Increased Risk of Incorrect Performance With New Device

Hagmolen of ten Have W, Van de Berg WN, Bindels PJ, Van Aalderen WM, Van der Palen J. J Asthma. 2008;45(1):67–71 PURPOSE OF THE STUDY. To assess the inhalation technique of asthmatic children with varying inhalation devices over time. STUDY POPULATION. The study included children between the ages of 6 and 7 years who were prescribed at least 2 β agonists or controller medications by a general practitioner during 2000–2003 in the Netherlands. METHODS. Inhalation technique was evaluated twice by using a standardized checklist first at enrollment in the study (n = 530) and 1 year later (n = 362). If children used >1 device, they were asked to demonstrate (with a placebo) their inhalation technique for the different inhalers. The study was observational, and no inhalation instructions were given. At enrollment, parents were questioned on previous inhalation instructions. RESULTS. A total of 131 (24%) children made ≥1 essential error with their inhaler devices initially. Children with a longer duration of asthma showed significantly more frequent incorrect inhaler performance. Incorrectly performing children with a metered-dose inhaler (MDI) with a spacer received less inhalation instruction by a health care worker as reported by the child or parent. The poor performance in children with a pressurized MDI was only slightly and not significantly better if they had received inhalation instruction (P = .2). Children who kept the same device more often demonstrated correct technique compared with the year before. This was irrespective of the type of inhaler and only significant for children with an MDI (without spacer). Despite this improvement after 1 year, children with an MDI again performed worse compared with all of the other inhaler types. Moreover, Discus and other dry-powder–inhalation devices were more often demonstrated correctly compared with MDIs with or without a spacer. Of the children who were prescribed a new device, 21% (24 of 114) demonstrated an incorrect technique compared with 11% (26 of 241) of the children who kept the same device (P = .01). Furthermore, 41% (37 of 91) of incorrect performances appeared to be correct 1 year later. Conversely, 4% (11 of 300) of the correct performances were incorrect at the end of the study. The MDI was still significantly and strongly associated with incorrect technique. CONCLUSIONS. Children are prone to use inhalation devices incorrectly if they are not monitored closely in correct use. Pressurized MDIs with and without a spacer were more prone to errors compared with dry-power inhalers. Children prescribed a new device were more prone to usage errors. REVIEWER COMMENTS. Although MDIs and dry-power–inhaler devices offer convenient and effective means of controller- and rescue-medication delivery, proper instruction and reinforcement of technique is essential to ensure proper use. Understanding the limitations of medication device delivery can assist the pediatrician in avoiding medication errors in asthmatic children. Device training for both children and their parents are an essential part of asthma education.

Assessment of Inhalation Technique in Children in General Practice: Increased Risk of Incorrect Performance with New Device

In a general practice based population 76% of 530 children inhaling asthma medication inhaled correctly. However, important differences among inhalers were found. Children with a pressurized metered-dose inhaler without a spacer device performed worst, with only 22% inhaling without essential errors. At a second evaluation of the inhaler technique, one year after the first assessment, performances with a new device were more often incorrect versus the unchanged devices (21.1% and 10.8%, respectively; p = 0.01). Providing children with a new device should be carefully controlled over time especially because these children are error prone.

Determinants of correct inhalation technique in children attending a hospital-based asthma clinic

Many children with asthma use their inhaler device incorrectly even after comprehensive inhalation instruction. The aim of this study was to identify factors associated with correct inhalation technique. Two hundred children with asthma demonstrated their inhalation technique. Patient characteristics and the components of inhalation instructions they had received were compared for children demonstrating a correct or incorrect inhalation technique. In addition, the inhalation technique of 47 newly referred patients was followed-up prospectively after repeated comprehensive instruction sessions. Seventy-eight percent of all patients demonstrated a correct inhalation technique. Patients who had received repeated instruction sessions and patients who had previously been asked to demonstrate the use of their inhaler during an instruction session were more likely than other children to demonstrate a correct inhalation technique (p < 0.001 and p = 0.03, respectively). Multiple logistic regression analysis showed that repetition of instructions was significantly associated with a correct inhalation technique (odds ratio (OR) 8.2, 95% CI 3.2-21.5; p < 0.0001) irrespective of type of inhaler used. Demonstration of the inhaler use by the patient was significantly associated with a correct inhalation technique for patients using a metered dose inhaler plus spacer device (OR 3.5, 95% CI 1.0-12.6; p = 0.05). but not for patients using a dry powder inhaler (OR 1.6, 95% CI 0.4-6.4; p = 0.54). The number of newly referred patients demonstrating a correct inhalation technique improved from 57.4% to 97.9% after three comprehensive instruction sessions. Inhalation instruction should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children.

Determinants of correct inhalation technique in children attending a hospital‐based asthma clinic

Many children with asthma use their inhaler device incorrectly even after comprehensive inhalation instruction. The aim of this study was to identify factors associated with correct inhalation technique. Two hundred children with asthma demonstrated their inhalation technique. Patient characteristics and the components of inhalation instructions they had received were compared for children demonstrating a correct or incorrect inhalation technique. In addition, the inhalation technique of 47 newly referred patients was followed‐up prospectively after repeated comprehensive instruction sessions. Seventy‐eight percent of all patients demonstrated a correct inhalation technique. Patients who had received repeated instruction sessions and patients who had previously been asked to demonstrate the use of their inhaler during an instruction session were more likely than other children to demonstrate a correct inhalation technique (p &lt; 0.001 and p= 0.03, respectively). Multiple logistic regression analysis showed that repetition of instructions was significantly associated with a correct inhalation technique (odds ratio (OR) 8.2, 95% CI 3.2–21.5; p &lt; 0.0001) irrespective of type of inhaler used. Demonstration of the inhaler use by the patient was significantly associated with a correct inhalation technique for patients using a metered dose inhaler plus spacer device (OR 3.5,95% CI 1.0–12.6; p= 0.05), but not for patients using a dry powder inhaler (OR 1.6,95% CI 0.4‐6.4; p= 0.54). The number of newly referred patients demonstrating a correct inhalation technique improved from 57.4% to 97.9% after three comprehensive instruction sessions. Conclusion: Inhalation instruction should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children.

311 Aerosols: How to improve inhalation technique in children

311 Aerosols: How to improve inhalation technique in children

Aerosol inhaler technique in children with asthma

Aerosol inhaler technique in children with asthma

Nasal inhalation as a cause of inefficient pulmonal aerosol inhalation technique in children.

In order to evaluate whether children can be taught the efficient use of a pressurized terbutaline aerosol with a tube spacer 71 children were given careful instruction in aerosol inhalation technique according to the manufacturer's instructions. Inhalation technique was assessed as being efficient when a child achieved an increase of more than 19% in FEV1 10 min after taking two puffs of terbutaline (each puff = 0.25 mg). After instruction about 37% of children aged 5-7 years and about 80% of children over 7 years were efficient in inhalation technique. Inhalation through the nose after actuation into the mouth accounted for about 50% of treatment failures, with the problem being more frequent in the younger age group. When this error was corrected about 83% of the children were efficient in the technique. Coordination problems and too rapid inspiration after actuation were also common errors. The findings stress the importance of checking all children's inhalation technique before prescribing inhalation therapy. Careful instruction was not enough. The possibility of nasal inhaling should be borne in mind when looking for causes of treatment failure.