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Inhaler Technique in Children With Asthma: A Systematic Review
Chris Gillette1, Nicole Rockich-Winston2, JoBeth A Kuhn2
1Marshall University School of Pharmacy, Huntington, WVa; Marshall University College of Health Professions, Huntington, WVa.
Insights
Pediatric asthma medication delivery relies on inhalation devices, but children often use them incorrectly. Educational interventions and proper instruction can improve inhaler technique and ensure effective asthma management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Public Health
Background:
- Pediatric asthma is a significant global health concern.
- Inhalation devices are the primary method for delivering asthma medication to children.
- Correct inhaler technique is crucial for effective medication delivery and asthma control.
Purpose of the Study:
- To determine the prevalence of correct inhaler technique in children with asthma.
- To assess if educational interventions improve inhaler technique rates.
- To investigate the association between improved inhaler technique and better asthma outcomes.
Main Methods:
- Systematic review of experimental and observational studies.
- Searches conducted across major databases including PubMed, Cochrane Library, CINAHL, and clinicaltrials.gov.
- Studies included if they reported on child/adolescent inhaler technique outcomes; quality appraised using Downs and Black checklist.
Main Results:
- Inhaler technique among children is generally poor, though better with metered-dose inhalers (MDIs) used with spacers.
- Technique for turbuhaler and Diskus devices is superior to MDI but remains suboptimal.
- Educational counseling on correct inhaler use demonstrated a positive association with improved technique in multiple studies.
Conclusions:
- Poor inhaler technique is a common issue in pediatric asthma management.
- Healthcare providers should consistently educate and correct children and caregivers on inhalation device use.
- Ensuring proper technique is vital for optimizing medication delivery and asthma control in pediatric patients.
Background:
Pediatric asthma is an important public health problem worldwide. The primary methods of medication delivery are inhalation devices.
Objectives:
This systematic review examined: 1) what is the prevalence of correct inhaler technique among children with asthma, 2) are educational interventions associated with improved rates of correct inhalation technique, and 3) is improved inhaler technique associated with improved asthma outcomes?
Data Sources:
We included experimental and observational studies through searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, and clinicaltrials.gov.
Study Eligibility Criteria, Participants, And Interventions:
Studies were eligible for this review if at least 1 outcome measure of the study included and reported results of child/adolescent inhaler technique.
Study Appraisal And Synthesis Methods:
The following information was extracted from each included study: study design (experimental vs observational), and outcomes data. The Downs and Black checklist was used to appraise study quality.
Results:
Twenty-eight studies were eligible for inclusion. We found that inhaler technique is generally very poor among children, but is better when children use their metered-dose inhalers (MDIs) with spacers. Technique in using turbuhalers and diskus inhalers is better than in MDI, but still poor. Counseling children on correct inhaler technique was associated with improved technique among children in multiple studies.
Limitations:
We examined articles published in English.
Conclusions And Implications Of Key Findings:
Inhaler technique in children is generally poor. Physicians and other members of the health care team should instruct children and their caregivers on the proper use of their inhalation devices at every opportunity and correct mistakes when made to ensure effective medication delivery.
Registry:
This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO CRD42015025070 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025070).
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