Results of a Physician and Respiratory Therapist Collaborative Effort to Improve Long-Term Metered-Dose Inhaler Technique in a Pediatric Asthma Clinic

BACKGROUND: Despite advances in therapy, asthma continues to be the chronic condition most responsible for school absenteeism and pediatric hospitalizations. This is especially true for innercity children. We operate an inner-city Pediatric Asthma Compliance and Technique (PACT) clinic in which physicians and respiratory therapists collaborate to improve metered-dose inhaler (MDI) technique and outcomes among asthmatic children.

OBJECTIVE: To determine the efficacy of our strategy for improving MDI technique and asthma outcomes.

METHODS: Children referred to the PACT clinic underwent standardized assessment based on the Expert Panel Guidelines of the National Heart, Lung, and Blood Institute (NHLBI). Clinicians demonstrated and reinforced correct MDI technique at each visit. Using a standardized format we prospectively collected, at the patient's first visit (T1) and most recent visit (T2), data on demographics, MDI-technique scores (MDI steps done correctly; scale of 0 – 8), pulmonary function, and asthma severity (NHLBI classification scale: 1 = mild intermittent to 4 = severe persistent). Statistical analyses were performed using parametric and non-parametric tests.

RESULTS: Of the 60 patients who attended the PACT clinic between 1999 and 2002, 15 were excluded from the study because of incomplete data recording. Mean duration from T1 to T2 was 11.8 ± 9.5 months. At T1 and T2, respectively, the mean MDI-technique scores were 53% and 81%, the mean overall asthma severity scores were 2.6 and 2.3, and the mean overall pulmonary function severity scores were 2.4 and 2.1. MDI-technique scores significantly improved between TI and T2 (p < 0.001). The black patients had the largest improvement in MDI technique (p < 0.001), but their pulmonary function test results, overall asthma severity, and pulmonary function severity did not improve significantly. The white patients significantly improved both their MDI technique (p = 0.004) and their overall asthma severity scores (p = 0.005).

CONCLUSION: In our PACT clinic asthmatic children showed sustained improvement in MDI technique, and some of the patients improved in pulmonary function and overall asthma severity score.