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Spacer compliance after discharge following a mild to moderate asthma attack
N G Cheng1, G J Browne, L T Lam
1The Emergency Department, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Aim:
To assess MDIS usage in patients discharged from a children's hospital emergency department following a mild to moderate asthma attack.
Methods:
Prospective observational study of 73 consecutive patients presenting to a children's hospital emergency department with a mild to moderate asthma attack. Demographic data, whether asthma literature/written MDIS instructions were provided, and who provided MDIS instructions (either a discharge coordinator or other emergency department staff) were noted. Parents of patients were telephoned after the first week following discharge and questioned about patient improvement, MDIS use/reasons for not using MDIS, and unscheduled presentations to their local doctor or hospital.
Results:
Following discharge, 50/73 (68.5%) patients used MDIS exclusively (compliers), while 23/73 used nebulisers some or all of the time (non-compliers). There was no difference in patient improvement or unscheduled presentations between compliers and non-compliers. Most non-compliers 14/23 (60.9%) changed because of parental preference; ease of nocturnal nebuliser use was a possible factor. Compliance was associated with the age of the patient, spacer usage at hospital, the size of device used at hospital, and whether an information fact sheet was given.
Conclusions:
Most children discharged from the emergency department following a mild to moderate asthma attack continue MDIS use exclusively in the first week. MDIS compliance may be associated with knowledge, experience, and ease of spacer usage. The study shows that education for parents is crucial for MDIS compliance.
Insights
Most children discharged after an asthma attack use their metered-dose inhaler (MDIs) correctly. Parental education and ease of spacer use are key factors for successful MDI compliance.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Asthma Management
Background:
- Metered-dose inhalers (MDIs) are commonly prescribed for pediatric asthma.
- Assessing adherence to MDI use post-emergency department discharge is crucial for effective asthma control.
Purpose of the Study:
- To evaluate the usage patterns of metered-dose inhalers (MDIs) in children after emergency department discharge for mild to moderate asthma attacks.
- To identify factors influencing MDI compliance in this patient population.
Main Methods:
- Prospective observational study involving 73 pediatric patients with mild to moderate asthma attacks.
- Data collected included demographics, MDI instruction provision, and follow-up phone interviews regarding MDI use and healthcare utilization.
- Adherence was categorized into exclusive MDI users (compliers) and those also using nebulizers (non-compliers).
Main Results:
- 68.5% of patients exclusively used MDIs post-discharge.
- No significant difference in clinical improvement or unscheduled visits between compliers and non-compliers.
- Parental preference and ease of nocturnal nebulizer use influenced non-compliance; compliance associated with patient age, spacer use, device size, and information fact sheets.
Conclusions:
- The majority of children continue exclusive MDI use in the week following emergency department discharge.
- MDI compliance is linked to parental knowledge, prior experience, and the ease of using associated spacer devices.
- Comprehensive parent education is vital for optimizing MDI adherence in pediatric asthma management.