Factors Associated With Effective Inhaler Technique Among Children With Moderate to Severe Asthma

To determine which individual and health care factors were associated with effective inhaler technique among urban children with persistent asthma.

The study included 130 parent-child dyads, age 4–17 years, with persistent asthma on inhaled corticosteroids daily for at least a year and had received oral corticosteroids within the preceding year. They were recruited from five pediatric clinic sites (3 general, 1 allergy, and 1 pulmonary) in Chicago, Illinois.

Inhaler technique of each parent-child dyad was scored using a validated scoring system, which included 12 steps for the inhaler-spacer subset and 10 steps for the inhaler-spacer-mask group. Effective inhaler technique was defined as performing greater than 75% of steps correctly.

Overall, 73.1% of children showed effective inhaler technique. There was no statistical difference in insurance, race, sex, asthma control, or specialty care between children with effective inhaler use versus misuse. Effective inhaler use was associated with younger age (8.9 years versus 11.3 years, P < .001). Overall, adolescents (14–18 y) had 80% lower odds of effective inhaler technique than children (4–8 y).

This study shows that adolescents with persistent asthma were less likely to have effective inhaler technique than younger children with persistent asthma. In this study, no other individual or health care factors were found to be associated with effective inhaler technique.

Asthma is prevalent among pediatric patients and is commonly encountered by both pediatricians and specialists. Successful control of asthma is imperative to limiting morbidity and mortality. Proper inhaler use is a simple way to improve asthma control; however, patients do not always know how to use their inhalers correctly. Physicians should review proper inhaler technique regularly, and, as shown in this study, both parents and patients should be actively involved in the training. Adolescence is a time when parental involvement in medical care may start to decrease and patients may be taking a greater role in their own medical care. Medical providers should consider spending additional time with adolescent patients reinforcing inhaler technique because this group is at a higher risk for inhaler misuse and, subsequently, poor asthma control and outcomes.