Nighttime Cough Research Articles

Do inhaled beta-agonists control cough in acute bronchitis?

EVIDENCE-BASED ANSWER Maybe. Pooled evidence from RCTs reveals no reduction in productive cough with use of beta-2-agonists (SOR: B, meta-analysis of 2 small RCTs). When the RCTs were evaluated separately, albuterol led to a 30% absolute decrease in cough at 7 days but had no effect on nighttime cough or productive cough. Fenoterol reduced productive cough but not total daytime or nighttime cough (SOR: C, small RCTs).

Simplification and Validation of Leicester Cough Questionnaire in Mandarin-Chinese

背景与目的患者行肺部手术后常常出现咳嗽，目前尚缺乏专门评估术后咳嗽的工具。本研究对中文版莱斯特咳嗽问卷（Leicester Cough Questionnaire in Mandarin-Chinese, LCQ-MC）改良并进行验证，探讨其临床应用价值。方法2015年9月-2016年12月四川大学华西医院胸外科单个医疗组共250例行胸腔镜肺部手术的患者参与调查，其中121例患者完成LCQ-MC，129例患者完成简化LCQ-MC，并进行信度和效度检验。结果新问卷保留LCQ-MC的框架与评分方式，由生理、心理和社会3个维度，共12个条目构成。量表内容效度良好，内容效度指数达到0.83；与日间咳嗽症状积分对比标准效度高（r=-0.578, P＜0.001），与夜间咳嗽症状积分和健康调查简表总分（Chinese version of the Medical Outcome Study 36-item Short-Form Healthy Survey, SF-36）对比标准效度中等（r=-0.358, P=0.004; r=0.346, P=0.030），与医院焦虑与抑郁评分总分（Hospital Anxiety and Depression Scale, HADS）对比标准效度较弱（r=-0.241, P=0.046）；内部一致性良好，克朗巴赫α系数在0.71-0.84之间；1周后重测信度良好（n=30, r=0.81-0.95）。结论简化版中文版莱斯特咳嗽问卷有良好的信度和效度，可应用于临床。

Long-term Recording of Night-Time Respiratory Symptoms in Patients with Stable COPD II–IV

ABSTRACTIntroduction: Night-time respiratory symptoms have a considerable impact on sleep and life quality in patients with chronic obstructive pulmonary disease (COPD). Lack of awareness of night-time symptoms can lead to worsened COPD control. Automated long-term monitoring of respiratory symptoms with LEOSound enables assessment of nocturnal wheezing and cough. Methods: In this observational study we investigated the prevalence and severity of cough and wheezing in patients with stable COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II–IV] disease for two consecutive nights with the LEOSound system. 48 patients (30 males, 63%) were eligible for inclusion, median age was 67 years, and body mass index (BMI) was 25.3 kg/m2. Results: In 15 out of 48 patients (31%), we found wheezing periods for at least 10-minute duration. Wheezing periods >30 minutes were monitored in seven patients and wheezing periods >60 minutes were monitored in three patients. The maximum duration of wheezing was 470 minutes in one patient with COPD II. The median wheezing rate differed between the COPD stages and between active and non-active smokers. Cough was found in 42 patients (87.5%) with a range of 1–326 events. The cough-period-index in night one was 0.83 n/hour (P25:0.33||P75: 2.04) and night two 0.97 n/hour (P25:0.25||P75: 1.9). Most of the cough events were non-productive with a median of 0.86. Conclusions: Night-time symptoms are common in COPD patients. LEOSound offers an opportunity to evaluate objectively night-time symptoms like wheezing and cough in patients with COPD which remain otherwise unnoticed. We found a high incidence of night-time wheezing in these patients, which was related to persistant smoking.

Correlation of induced sputum eosinophil levels with clinical parameters in mild and moderate persistent asthma in children aged 7–18 years

ABSTRACTBackground: Treatment decisions in asthma are currently based on clinical assessment and spirometry. Sputum eosinophil, being a marker of airway inflammation, can serve as a tool for assessing severity and response to treatment in asthma patients. Objectives: To measure eosinophil percentage in induced sputum in children with asthma and correlate it with clinical asthma parameters. Methods: A prospective observational study was performed at tertiary care hospital on 91 children aged 7–18 years with newly diagnosed mild or moderate persistent asthma. Theinduced sputum eosinophil percentage was obtained at the time of enrollment and three months after treatment with inhaled budesonide. Patients were specifically evaluated for five clinical parameters of asthma, i.e., days of acute exacerbations, use of salbutamol as rescue medication, emergency visits, nighttime cough and days of school absence. Results: Sputum eosinophil percentage was high (3.1 ± 0.515%) at the time of enrollment which reduced significantly after three months of inhaled budesonide therapy [0.06 ± 0.164% (p < 0.0005)]. Children with moderate persistent asthma had significantly higher values of sputum eosinophil levels than children with mild persistent asthma at the time of enrollment (3.38 ± 0.64% vs. 2.99 ± 0.42%, p = 0.001) but the difference was not significant after three months of inhaled steroid therapy (0.07 ± 0.18 vs. 0.04 ± 0.12, p = 0.5104). A significant negative correlation was found between reduction in sputum eosinophil levels and improvement in FEV1 (r = −0.400, p = 0.0001). All the clinical asthma parameters also correlated significantly with the reduction in sputum eosinophil levels after three months of inhaled steroid therapy. Conclusion: Eosinophil levels in induced sputum correlate well with clinical asthma parameters and asthma severity in children. It is a simple, noninvasive and cheap method which can be used for the monitoring of asthma in a resource-limited setting.

Prevalence of cough throughout childhood: A cohort study.

BackgroundCough in children is a common reason for medical consultations and affects quality of life. There are little population-based data on the epidemiology of recurrent cough in children and how this varies by age and sex, or between children with and without wheeze. We determined the prevalence of cough throughout childhood, comparing several standardised cough questions. We did this for the entire population and separately for girls and boys, and for children with and without wheeze.MethodsIn a population-based prospective cohort from Leicestershire, UK, we assessed prevalence of cough with repeated questionnaires from early childhood to adolescence. We asked whether the child usually coughed more than other children, with or without colds, had night-time cough or cough triggered by various factors (triggers, related to increased breathing effort, allergic or food triggers). We calculated prevalence from age 1 to 18 years using generalised estimating equations for all children, and for children with and without wheeze.ResultsOf 7670 children, 10% (95% CI 10–11%) coughed more than other children, 69% (69–70%) coughed usually with a cold, 34% to 55% age-dependently coughed without colds, and 25% (25–26%) had night-time cough. Prevalence of coughing more than peers, with colds, at night, and triggered by laughter varied little throughout childhood, while cough without colds and cough triggered by exercise, house dust or pollen became more frequent with age. Cough was more common in boys than in girls in the first decade of life, differences got smaller in early teens and reversed after the age of 14 years. All symptoms were more frequent in children with wheeze.ConclusionsPrevalence of cough in children varies with age, sex and with the questions used to assess it, suggesting that comparisons between studies are only valid for similar questions and age groups.

Effect of aclidinium bromide on cough and sputum symptoms in moderate-to-severe COPD in three phase III trials

BackgroundCough and sputum are troublesome symptoms in chronic obstructive pulmonary disease (COPD) and are associated with adverse outcomes. The efficacy of aclidinium bromide 400 µg twice daily in patients with...

The immunoregulation and clinical effect of Yupingfeng capsule combined with Seretide on patients with cough variant asthma

Objective To detect the immunoregulation and clinical effect of Yupingfeng capsule combined with Seretide on patients with cough variant asthma (CVA). Methods CVA Patients were randomly divided into the Seretide control group (n=54) and Yupingfeng capsule combined with Seretide group (n=54). Seretide group received inhaled Seretide. Combined traditional Chinese medicine group received Seretide and Yuping Feng capsule. Two groups were treated for 12 weeks. The IL-17, IL-10 and IL-6 expression was detected by ELISA analysis. The clinic effect rate and adverse events were compared. Results After treatment, compared with the Seretide group, the expression of IL-17 (18.72±4.26 ng/ml vs. 26.17±5.58 ng/ml; t=2.462, P<0.05) and IL-6 (21.58±4.12 ng/ml vs. 30.66±6.27 ng/ml; t=2.523, P<0.05) were significantly lower in combined traditional Chinese medicine group than that in Seretide group; and IL-10 (15.56±2.74 ng/ml vs. 12.25±2.81 ng/ml; t=2.244, P<0.05) was significantly higher in combined traditional Chinese medicine group. The daytime (1.12±0.26 vs.1.42±0.33, t=2.283) and night time cough score (1.24±0.28 vs. 1.52±0.37, t=2.291) in combined traditional Chinese medicine group was significantly lower than that in Seretide group (P<0.05). The clinic effect rate (92.6% vs. 77.8%, χ2=2.438) in combined traditional Chinese medicine group was significantly higher than that in Seretide group (P=0.037). Conclusion Yupingfengcapsule combined with Seretide can decrease IL-17 expression and increase IL-10 expression to inhibit inflammatory reaction in CVA patients, and showed significantly higher clinical effect rates. Key words: Asthma; Yupingfeng capsule; Seretide; Immunoregulation; Outcome assessment

Upper Respiratory Tract Infections

Upper Respiratory Tract Infections

Ten-year longitudinal study of factors influencing nocturnal asthma symptoms among Asian patients in primary care.

Background:Nocturnal asthma symptoms result in poor quality of life and morbidity.Aims:This study primarily examines key factors predicting and mitigating nocturnal symptom risks among asthma patients, who were enrolled into a Singapore publicly funded asthma care programme. It also studies the association between nocturnal symptoms and medication changes as the secondary outcome.Methods:A longitudinal study was conducted on 939 multi-racial Asian patients with persistent asthma. Patient clinical and therapeutic data were retrieved retrospectively from the programme’s database established in 2004. Association between nocturnal symptoms (defined as night-time cough, wheeze and breathlessness at least twice monthly) and each categorical predictor was tested. The generalised linear mixed-effects model (GLIMM) was used to model the primary and secondary outcomes.Results:Having nocturnal asthma symptoms was significantly associated with the number of days with breathlessness, off usual activities and off work, and asthma severity at baseline (all P values <0.05). The asthma action plan (AAP) status is significantly associated with nocturnal symptoms after adjusting for race, age and smoking status at baseline (odds ratio (OR)=0.49 (updated asthma action plan versus none), OR=0.37 (been-on plan versus none)). The risks of nocturnal asthma symptoms increased over time for those with allergic rhinitis (OR=1.52) and reduced with subsequent visits (OR=0.91). Nocturnal symptoms increased the odds (OR=2.87) of switching from inhaled corticosteroid (ICS) to combination medications (ICS-LABA (long-acting β2-agonist)).Conclusions:The risks of having nocturnal symptoms were primarily associated with those with allergic rhinitis. An increase in patients’ nocturnal symptoms was also predictive of the switching from ICS medications to combination formulations by their physicians.

Antibiotics for acute bronchitis.

Are antibiotics associated with improved outcomes in patients with acute bronchitis? Prescribing antibiotics for acute bronchitis was associated with reduced overall and nighttime cough and with an approximately half-day reduction in duration of cough, in days feeling ill, and in days with impaired activities. However, at follow-up, there were no significant differences in patients receiving antibiotics compared with those receiving placebo in overall clinical improvements or limitations in work or other activities. There was a significant increase in adverse effects in the antibiotic group, particularly gastrointestinal symptoms.

P8 Objective Cough Frequency Monitoring In Bronchiectasis

Introduction and objectives Cough is a major symptom in bronchiectasis. Cough monitors are emerging as an important tool that assesses cough objectively. The aim of this cross-sectional study was to assess cough frequency in non-cystic fibrosis bronchiectasis, investigate its association with patient-reported symptoms and health-related quality of life (HRQOL), and investigate potential factors of cough frequency variability. Methods Patients with non-cystic fibrosis bronchiectasis were recruited from 2 outpatient bronchiectasis clinics. All patients underwent 24-hour ambulatory cough monitoring with the Leicester Cough Monitor, and reported sleeping time in a diary. The patients also completed the Leicester Cough Questionnaire (HRQOL), and visual analogue score (VAS) for sputum and cough severity. Sputum bacteria colonisation status was assessed, and defined as at least 2 positive cultures, minimum 3 months apart and within one year. Results 49 patients were recruited; median (IQR) age 65 (52, 70) years, 64% female. The aetiology of bronchiectasis were: idiopathic (45%), post infective (29%) and other (25%). The prevalence of sputum colonisation were: pseudomonas aeruginosa 38% and other organisms 29% of patients. Median (IQR) 24-hour, day time and night time cough counts were: 249 (112, 438), 240 (109, 404.5) and 24 (5, 56.5) coughs respectively. There was diurnal variation in cough frequency (Figure 1). Day time cough frequency was significantly greater than night time (Wilcoxon signed rank test p Conclusions Cough frequency monitoring in patients with bronchiectasis is feasible. Higher cough frequency was associated with poorer HRQOL and worse patient-reported symptoms of cough and sputum. Patients coughed more during the day than at night. 24-hour cough frequency was variable and gender was identified as an influential factor. Future studies should investigate other potential factors for cough variability in bronchiectasis and evaluate the potential of cough frequency as an outcome measure for assessing the efficacy of therapy.

A randomized, placebo-controlled, double-blind trial on the management of post-infective cough by inhaled ipratropium and salbutamol administered in combination

Post-viral cough is a type of cough originating from upper respiratory tract infections that persists after the infection is resolved. Although it was hypothesized that bronchodilators might have a role in the management of post-viral cough, a clear demonstration of their efficacy is missing. Therefore, we tested the efficacy of a combination of a β-agonist and an anticholinergic agent in reducing post-viral cough with a randomized, double blind, placebo controlled clinical trial.Patients were treated for 10 days with either a nebulized combination of salbutamol 1.875 mg/0.5 mL and ipratropium bromide 0.375 mg/0.5 mL, or a placebo, and followed up for another 10 days. Daytime and nighttime cough severity and spirometry testing were assessed before starting treatment, after 10 and 20 days.Ninety-two patients were randomized to receive placebo (n = 46) or the active treatment (n = 46); nine of them (4 in the placebo group, 5 in the active treatment group) dropped out from the study. Daytime and nighttime cough severity were significantly reduced in both groups during the study period, but the reduction was more prominent in the active treatment group vs. placebo after 10 days of treatment (P = 0.003 for day cough; P = 0.061 for night cough), whereas at the end of follow-up period cough severity was comparable between the two groups. Small but significant increases in spirometric parameters were observed in the active treatment vs. placebo group, although at the end of follow-up these values returned to be comparable to placebo. The frequency of adverse events was not significantly different between the two groups of patients.We concluded that a combination of a β-agonist and an anticholinergic agent can effectively reduce post-viral cough, and can thus represent a valid option for this type of cough.

Sleep disturbances and health-related quality of life in adults with steady-state bronchiectasis.

BackgroundSleep disturbances are common in patients with chronic lung diseases, but little is known about the prevalence in patients with bronchiectasis. A cross sectional study was conducted to investigate the prevalence and determinants associated with sleep disturbances, and the correlation between sleep disturbances and quality of life (QoL) in adults with steady-state bronchiectasis.MethodsOne hundred and forty-four bronchiectasis patients and eighty healthy subjects were enrolled. Sleep disturbances, daytime sleepiness, and QoL were measured by utilizing the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and St. George Respiratory Questionnaire (SGRQ), respectively. Demographic, clinical indices, radiology, spirometry, bacteriology, anxiety and depression were also assessed.ResultsAdults with steady-state bronchiectasis had a higher prevalence of sleep disturbances (PSQI>5) (57% vs. 29%, P<0.001), but not daytime sleepiness (ESS≥10) (32% vs. 30%, P = 0.76), compared with healthy subjects. In the multivariate model, determinants associated with sleep disturbances in bronchiectasis patients included depression (OR, 10.09; 95% CI, 3.46–29.37; P<0.001), nocturnal cough (OR, 1.89; 95% CI, 1.13–3.18; P = 0.016), aging (OR, 1.04; 95% CI, 1.01–1.07; P = 0.009) and increased 24-hour sputum volume (OR, 2.01; 95% CI, 1.22–3.33; P = 0.006). Patients with sleep disturbances had more significantly impaired QoL affecting all domains than those without. Only 6.2% of patients reported using a sleep medication at least weekly.ConclusionsIn adults with steady-state bronchiectasis, sleep disturbances are more common than in healthy subjects and are related to poorer QoL. Determinants associated with sleep disturbances include depression, aging, nighttime cough and increased sputum volume. Assessment and intervention of sleep disturbances are warranted and may improve QoL.

Efficacy of Grintuss® pediatric syrup in treating cough in children: a randomized, multicenter, double blind, placebo-controlled clinical trial.

BackgroundCough is an extremely common problem in pediatrics, mostly triggered and perpetuated by inflammatory processes or mechanical irritation leading to viscous mucous production and increased sensitivity of the cough receptors. Protecting the mucosa might be very useful in limiting the contact with micro-organisms and irritants thus decreasing the inflammation and mucus production. Natural molecular complexes can act as a mechanical barrier limiting cough stimuli with a non pharmacological approach but with an indirect anti-inflammatory action.ObjectiveAim of the study was to assess the efficacy of a medical device containing natural functional components in the treatment of cough persisting more than 7 days.MethodsIn this randomized, parallel groups, double-blind vs. placebo study, children with cough persisting more than 7 days were enrolled. The clinical efficacy of the study product was assessed evaluating changes in day- and night-time cough scores after 4 and 8 days (t4 and t8) of product administration.ResultsIn the inter-group analysis, in the study product group compared with the placebo group, a significant difference (t4 study treatment vs. t4 placebo, p = 0.03) was observed at t4 in night-time cough score.Considering the intra-group analysis, only the study product group registered a significant improvement from t0 to t4 in both day-time (t0 vs. t4, p = 0.04) and night-time (t0 vs. t4, p = 0.003) cough scores.A significant difference, considering the study product, was also found in the following intra-group analyses: day-time scores at t4 vs. t8 (p =0.01) and at t0 vs. t8 (p = 0.001); night-time scores at t4 vs. t8 (p = 0.05), and at t0 vs. t8 (p = 0.005). Considering a subgroup of patients with higher cough (≥3) scores, 92.9% of them in the study product group improved at t0 vs. t4 day-time.ConclusionsGrintuss® pediatric syrup showed to possess an interesting profile of efficacy and safety in the treatment of cough persisting more than 7 days.

New Guidelines for Asthma Management

Asthma is a chronic airway inflammatory disease that is characterized by symptoms such as shortness of breath, wheezing, chest tightness, and nighttime or early morning coughing, together with variable expiratory airflow limitation. Asthma is a heterogeneous disease involving various underlying processes that have been described based on causal or exacerbating factors, the pattern of airflow obstruction, severity of disease, pattern of cellular inflammation, and structural changes among patients with asthma. However, there is considerable overlap among these clinical variants, which are not correlated strongly with specific pathological processes or treatment responses. The Global Strategy for Asthma Management and Prevention 2014 (GINNA 2014) emphasizes the importance of confirming the diagnosis to minimize both under- and over-treatment with respect to the heterogeneity of asthma. To assess asthma control, it is necessary to assess not only the symptom control but also the future risks of an adverse outcome. Lung function is the most used indicator of future risk. This article reviews the treatment of adult asthma, including patients already receiving treatment according to GINA 2014 and the Health Insurance Review and Assessment Service. (Korean J Med 2014;87:156-162)

Daytime Sleepiness and Quality of Sleep in Patients with COPD Compared to Control Group

Objectives:Chronic obstructive pulmonary disease (COPD) is a widespread disease. It produces some night symptoms such as nighttime cough and dyspnea. Then subjective and objective changes in sleep pattern are expected. Present study was conducted to determine frequency of sleepiness and quality of sleep in patients with COPD.Materials & Methods:Present case-control study has been performed on 120 patients with diagnosis of COPD who had been referred to pulmonary disease clinic in a University teaching hospital. One hundred twenty age- and sex- matched healthy individuals were recruited in the study and served as control. Spirometry (PFT) was performed for all patients. Patients were categorized under 3 groups in relation to their PFT as follow: mild COPD (FEV1/FVC<70% and FEV1≥80%), moderate COPD (FEV1/FVC<70% and 50%≤FEV1<80%), and severe COPD (FEV1/FVC<70% and FEV1<50%). Pittsburgh Sleep Quality questionnaire (PSQI) and Epworth Sleepiness Scale (ESS) were used to estimate quality of sleep and daytime sleepiness in the patients and control group. The collected data were analyzed using version 16 SPSS software. Student’s T- test, Chi- square and multiple logistic regressions were used as appropriated.Results:120 patients with COPD (79 males and 41 females) and 120 normal individuals responded to the questionnaires. Mean scores of quality of sleep were 8.03±3.66 and 4.2±2.8 in COPD patients and control group respectively. 32.1% of the patients had good sleep quality (PSQI score less than 5) and 67.9% had poor sleep quality. Daytime sleepiness (ESS≥ 10) was present in 34.8% of the patients and 15% of control people. Multiple logistic regressions showed that the patients reported significantly worse sleep quality and more daytime sleepiness than control group [OR=2.9; 95% CI (1.6-3.7) & OR=3.5; 95% CI (2.5-4.3) respectively].Conclusion:Results of present study confirmed that COPD is associated with daytime sleepiness and poor quality of sleep, possibly attributable to nighttime respiratory difficulties and concomitant sleep apnea. Assessment of the patients for symptoms of sleep apnea, daytime sleepiness should be a part of regular follow up visits of patients with COPD.

A Multi-centre, Randomised, Double-blind, Placebo-controlled Clinical Trial on the Efficacy and Tolerability of GeloMyrtol® forte in Acute Bronchitis

GeloMyrtol® forte (Myrtol®) is a phytomedicine obtained by distillation from essential oils. The trial was conducted to confirm the efficacy of Myrtol® in the treatment of acute bronchitis. Patients with acute bronchitis and without confounding co-morbidity or co-medication were randomly assigned to treatment with either Myrtol® 300 mg 4 times daily or matched placebo in double-blind, parallel-group fashion. Signs and symptoms were evaluated by the investigator at baseline and after 7, 10 and 14 days of treatment; intake of medication, wellbeing and symptoms were recorded daily by the patient in the patients' diaries. 413 patients were enrolled and randomised (Myrtol®: 202; Placebo: 211); 398 had at least one on-treatment efficacy evaluation (Myrtol®: 196; Placebo: 202). The mean change in coughing fits from D01 (baseline) to D07-D09 (after about one week treatment) was 62.1% (95% CI: 57.6-66.6%) and 49.8% (95% CI: 44.6-55.0%) for treatment with Myrtol® and placebo, respectively (p<0.0001). With Myrtol®, the median time to 50% reduction in coughing fits was statistically significantly shorter and there were more patients without day-time coughing fits; there also were statistically significantly less day-time coughing fits, less difficulty coughing up, less sleep disturbance due to night-time coughing; with Myrtol® there was less symptomatic impairment (composite bronchitis severity score and subscores) and significant more patients had a clinically satisfying response to the investigational treatment.Both treatments were generally well tolerated. Myrtol® is statistically significantly superior to placebo in treating acute bronchitis.

Honey Helps Kids with Nocturnal Cough

In children with nighttime cough, honey appears to offer symptom relief and improve sleep quality, according to a study funded, in part, by the Honey

Vapor rub appears to decrease nighttime cough in children with upper respiratory infections

Vapor rub appears to decrease nighttime cough in children with upper respiratory infections

The Evaluation of an Education Program for Using an Inhaler Devices in Childhood Asthma

Purpose:Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. Methods:A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharma- cists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. Results:Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). Conclusion:The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary. (Pediatr Allergy Respir Dis(Korea) 2011;21:108-114)