Inhaler technique in acute wheezing: Factors associated with adequate knowledge

To assess knowledge and skills in the use of spacer devices among children presenting to a pediatric emergency department with an acute exacerbation of wheezing or asthma and among their caregivers, and to identify associated factors.

We conducted a cross-sectional descriptive study in 134 children aged 2-15 years with previous spacer use who presented with an acute exacerbation of wheezing or asthma. Eligible patients had either a prior physician diagnosis of asthma or a history of recurrent wheezing (≥3 previous episodes). Knowledge and skills were assessed in caregivers and children capable of using the device independently ("autonomous children") by means of a checklist developed in house based on current guidelines. Performance was classified into four levels according to the percentage of correctly performed items. We conducted logistic regression analyses to identify factors associated with adequate knowledge.

Overall, 63.4% of participants showed a high level of knowledge regarding spacer use. Caregivers demonstrated better performance compared to autonomous children (77.7% vs 30%). Better knowledge was directly associated with younger age and follow-up in pediatric pulmonology department in autonomous children, and inversely associated with age in caregivers. Despite generally favorable results, relevant technique errors were frequent, particularly among autonomous children.

Most caregivers demonstrated adequate knowledge of spacer use; however, significant errors persist, especially among autonomous children. These findings highlight the need for repeated and structured educational interventions.