The Survey Of The Use Of Inhalers In Asthmatic Children

Objectives:It aims to assess the inhaler techniques of asthmatic children in our asthma clinic,to identify clinical characteristics and asthma-related outcomes associated with poor inhaler techniques,and Investigate children or their caregivers’level of asthma knowledge and the compliance and negative attitudes toward treatment.Methods:A total of 180 asthmatic children participated in the presented study,treated with ICS or ICS+LABA at least 4 weeks,in the clinic of the Second Hospital of Tianjin Medical University,from March to July 2018.Their inhaler techniques were assessed by pediatric specialists using a validated scoring system and they have received introductions of device usage at least once.Demographic data were gathered with questionnaires.The important maneuvers had to be observed directly and assessed using an inhaler-specific checklist of steps of pMDI+spacer~?,Accuhaler~?and Turbuhaler~?,respectively.Student’s t-test,χ~2 test,non-parametric test and Logistic regression were used to identify clinical characteristics and asthma-related outcomes associated with poor inhaler techniques.Results:1.Patients using different inhalers 180 patients were recruited,male=117(65.00%),female=63(35.00%),with age of 1-16(7.43±3.07)years old.There were 68(37.78%),51(28.33%)and 61(33.89%)patients using pMDI+spacer~?,Accuhaler/Diskus~?and Turbuhaler~?,respectively.2.Assessment of the inhaler techniques(1)Overall assessment“0 error”accounted for 38.89%,“≥1 errors”66.11%.There were 24(35.29%),42(82.35%),53(86.89%)patients making“≥1 errors”in the groups of pMDI+spacer~?,Accuhaler~?and Turbuhaler~?,respectively.(2)Common errors The most frequent errors of pMDI+spacer~?were no shaking the inhaler well before every use,and inhalation errors(including depth of inspiration,coordination problem and ineffective seal lips around the mouthpiece)and no rinsing mouth.The most frequent errors of Accuhaler~?were expiration errors(including no full expiration before inhalation and exhaling into the inhaler),inhalation errors(including ineffective seal lips around the mouthpiece,insufficient inspiratory effort),twist error(device not held horizontally),no rinsing mouth,and no post-inhalation breath-hold.The most frequent errors of Turbuhaler~?were expiration errors(including no full expiration before inhalation and exhaling into the inhaler),twist error(device not held upright),inhalation errors(including ineffective seal lips around the mouthpiece,insufficient inspiratory effort),incorrect preparation,no full expiration before inhalation,no post-inhalation breath-hold and no rinsing mouth.3.Factors affecting the inhaler techniques(1)It showed that age,device types,caregivers’relationship with children,body mass index(BMI),fractional exhaled nitric oxide(FENO),and allergen immunotherapy(AIT)were relevant to inhaler techniques.(2)There was no significant difference between“0 error”group and“≥1 errors”group among the severity of asthma,asthma control,exacerbations in the previous year,any drug withdrawal,the number of follow-ups,allergens and lung function,and the scores of Asthma Knowledge Questionnaire,Questionnaire of medication philosophy,and Morisky medication adherence scale.4.Types of inhaler device and inhaler techniques Logistic regression analysis showed that the inhaler technique was related to the types of inhaler device(OR=0.07,95%CI:0.016-0.298,p<0.001),and the risk of“≥1 errors”observed in children with pMDI+spacer~?was reduced by 93%compared to that in children with Accuhaler~?and Turbuhaler~?.5.Inhaler techniques and Asthma Knowledge Questionnaire It showed that scores of children or caregivers were(9.84±1.66)points,and the scores of the two groups were(9.79±1.14)、(9.87±1.88)points,respectively.The difference between the“0 error”group and“≥1 errors”group was not statistically significant(p=0.765).Most of them knew the basic knowledge of asthma such as nature of asthma(95.56%),risk factors(95.00%-96.11%),treatment of asthma(97.78%),control of asthma(94.44%-97.22%);70.00%to 76.11%could deal with asthma exacerbations quickly;a few had an understanding of PEF monitoring(11.67%)or GINA(5.56%).6.Inhaler techniques and Questionnaire of medication philosophy It showed that scores of children or caregivers were(6.41±1.61)points,and the scores of the two groups were(6.52±1.60)、(6.34±1.63)points,respectively.There was no significant difference between the two groups(p=0.400).Among 180 patients,30.00%had good adherence,about 44.44%had medium adherence,and about 25.56%had poor adherence.About 42.22%had forgotten to use their inhaler devices;about 18.89%had forgotten to use the inhaler devices for one day or more in the previous 2 weeks;about 37.22%had drug withdrawal.The most common reasons for drug withdrawal:“I believe that the asthma has been controlled or healed”(33.82%),“I worried about side-effects”(32.35%),and“I cannot follow up in time”(29.41%).7.Inhaler techniques and Morisky medication adherence scale It showed that scores of children or caregivers were(3.09±1.63)points,the scores of the two groups were(3.15±1.75)and(3.07±1.57)points,respectively,and no difference was found between the two groups(p=0.755).The most common concerns:“Inhaler devices will disturb the current life”(86.11%),“I worry about the side-effects of ICS”(74.44%),and“I worry about long-term use of ICS”(75.00%).Conclusion:1.Inhaler techniques are generally poor in children with asthma.The inhaler techniques of pMDI+spacer~?are better than those of DPI;the level of inhaler techniques of children cared by grandparents is higher than that of parents,and the latter should be strengthened with inhaler train.The longer the inhaler device is used,the more likely it is to have inhaler technique errors,and the inhaler techniques should be rechecked and directed at every follow-up.2.It is not found that poor inhaler techniques are associated with asthma-related outcomes,such as the severity of asthma,asthma control in the previous month,exacerbations in the previous year.Therefore,the sample size should be expanded and follow-up should be continued.3.Asthmatic children or their caregivers have a high level of awareness of the nature and causes of asthma,lack of understanding of asthma medication and self-management,which is one of the main reasons for compliance and negative attitudes.It’s vital to improve asthma knowledge and self-management.