Is the correct use of a dry powder inhaler (Turbohaler) age dependent?,☆☆

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Abstract

Background: The metered-dose inhalers are the most commonly used devices in the treatment of asthma, but dry powder inhalers (eg, Turbohaler) are being increasingly used. Studies evaluating how well children can use a Turbohaler are lacking. Objective: We assessed whether the correct use of a Turbohaler could be easily taught to unselected stable asthmatic children. Methods: One hundred sixty-one asthmatic children aged 5 to 17 years (mean, 9.8 years) consecutively attending the outpatient clinic were included in study. After a demonstration and 10 minutes of training, the inhalation technique was checked in a standardized way (yes/no response). Keeping the device upright, proper preparation of the drug dose and inspiratory flow on inhalation were measured by the Turbohaler trainer. Results: One hundred thirty-three children (83%) performed every step correctly (ie, 96% of children older than 8 years but only 55% of children between 5 and 8 years; P < .001). Of 28 children incorrectly using the Turbuhaler-trainer, 20 generated insufficient inspiratory flow through the device. There was no significant difference in airway obstruction (expressed as percent of predicted forced vital capacity, FEV1 , and Tiffeneau index) between correct and incorrect users, but when measured through the pneumotachograph, mean peak inspiratory flow (expressed as percent predicted) was significantly lower in those children incorrectly using the device. Turbohaler use was reevaluated after 4.7 ± 2.0 months in a subset of 64 patients. Fifty-three of 64 (83%) children again used the device correctly. Only 3 of 13 who used the device incorrectly at the first evaluation used it correctly at the second evaluation. Conclusions: We conclude that the correct use of the Turbohaler can be easily taught to asthmatic children older than 8 years. Those who use the device correctly after initial instructions continue to do so afterwards. (J Allergy Clin Immunol 1999;103:763-7.)

Section snippets

Patients

All children attending the asthma outpatient clinic were consecutively included in this study, provided that they had never used a dry powder inhaler and were 5 years of age or older.

Study design

The Turbohaler-trainer is a device simulating the Turbohaler and allowing a semiquantitative measurement of peak inspiratory flow (PIF). Activation of 0, 1, 2, and 3 light-emitting diodes (LEDs) are reported to correspond to flows less than 20, 21 to 40, 41 to 60, and more than 60 L·min–1, respectively. This report

First assessment

A first assessment of Turbohaler use was done in 166 children attending the asthma clinic. Of them, 5 could not perform pulmonary function tests and therefore were excluded from further evaluation. The mean age of these patients was 6.8 years (range, 6.3 to 7.4 years). One hundred sixty-one children (94 boys and 67 girls), ranging in age from 5 to 17 years (Table I), comprised the study group.One hundred thirty three of these 161 (83%) children could perform every step correctly. Of 28 children

DISCUSSION

Nearly all children 8 years of age and older could be easily taught to correctly use a Turbohaler device; in about half of the children below that age were we able to do so. Those who used the device correctly continued to do so on follow-up. The restrictions to optimal use were the inability to generate sufficient inspiratory flow through the Turbohaler and the inability to correctly prepare a drug dose. The latter could be performed by a parent, thereby increasing the proportion of possible

References (28)

  • LB Ribeiro et al.

    Comparison of Bricanyl Turbuhaler and Berotec dry powder inhaler

    Allergy

    (1990)
  • J van der Palen et al.

    Poor technique in the use of inhalation drugs by patients with chronic bronchitis/pulmonary emphysema

    Ned Tijdschr Geneeskd

    (1994)
  • American Thoracic Society

    Standardization of spirometry. 1994 Update

    Am J Respir Crit Care Med

    (1995)
  • PH Quanjer et al.

    Compilation of reference values for lung function measurements in children

    Eur Respir J

    (1989)
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    Reprint requests: Kris De Boeck, MD, PhD, Pediatric Pulmonology, Department of Pediatrics, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.

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