An Evaluation of Children's Metered-dose Inhaler Technique for Asthma Medications

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Purpose

The purposes of this study were to: (1) describe the accuracy of children's MDI technique, (2) identify common mistakes made by children using MDIs, and (3) determine whether teaching the correct MDI technique to children resulted in fewer errors and improved performance. In addition, new drug delivery devices for asthma medications and their implications for patient care are discussed.

Review of relevant literature

The National Heart, Lung, and Blood Institute's [3] “Guidelines for the Diagnosis and Management of Asthma” identified pharmacologic therapy as integral to asthma management. Inhaled medications are frequently prescribed for children with asthma because they deliver the medication directly to the lungs, provide a faster onset of action, and allow smaller doses of the drug to be effective [4].

Unfortunately, many children who have asthma do not use their inhalers correctly. Scarfone et al [5]

Design

MDI administration technique was assessed for children with persistent asthma who participated in a randomized, controlled intervention study evaluating the effectiveness of an asthma self-management program [10], [11]. Pre- and postintervention assessments of the children's MDI technique were collected during two nurse-led asthma education sessions in the 5-week clinical trial. Teaching of appropriate MDI administration technique occurred after the baseline assessment and was reinforced after

Results

Ninety-two percent of the children evaluated used their MDI incorrectly (ie, fair to poor) during the pretest; however, less than one fifth of the participants (19%, n = 7) exhibited incorrect MDI technique after the intervention (Fig. 1). The most common mistakes in the pretest included: (1) not holding breath for at least 10 seconds after actuation (56%), (2) not waiting at least 1 minute between inhalations (50%), (3) inadequately shaking the medication (42%), (4) not inhaling fully (42%), and

Discussion

The results of this study were consistent with prior studies of MDI technique in children. The majority of the children used incorrect technique, although they had been diagnosed with persistent asthma and needed to use an MDI for an average of 5 years. Educating pediatric patients and their parents about the proper use of an inhaler significantly increased the frequency of good technique (8% of children before teaching versus 81% after teaching). However, approximately one fifth of the

Implications for practice

The results of this study underscore the critical importance of clinicians reinforcing medication delivery technique with children and their families at every visit. Parents and children need to understand how, when, and why they take their medicines and should have the opportunity to practice and review their technique with the health care provider.

Summary

Regardless of the medication delivery system, health care providers need to teach accurate medication administration techniques to their patients, educate them about the particular nuances of the prescribed delivery system (eg, proper storage), and reinforce these issues at each health encounter. A single instruction session is not sufficient to maintain appropriate inhaler techniques for patients who require continued use [26]. Providing written steps for the administration technique is

Acknowledgments

This work was supported by Grant # NUR-017 from GlaxoSmithKline (Clinical Applications Research) awarded to Dr. Burkhart. The authors gratefully acknowledge the critical review of the manuscript by Dr. Lynne Hall, Assistant Dean for Research and the PhD Program, College of Nursing, University of Kentucky. The research was presented as a paper presentation at the Southern Nursing Research Society Conference in Louisville, KY in February 2004.

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    This study was approved by the Medical Institutional Review Board at the University of Pittsburgh. Only children whose parents gave written consent for them to participate in the 5-week asthma self-management clinical trial were included.

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