Emphasizing of Shaking the Inhaler as Part of Inhalation Instruction is Important in Young Asthmatic Children

Background: Current guidelines recommend to monitor inhalation technique in asthmatic children every 3-6 months. The aim of this study was to investigate inhalation technique 6 weeks after instruction in young asthmatic children, using a pressurized metered dose inhaler with spacer.

Methods: 91 asthmatic children, 4-8 years, from our outpatient clinic, demonstrated their inhalation technique with a pressurized metered dose inhaler with spacer. Errors in inhalation technique were scored on an inhaler specific standardized checklist designed by the Dutch Lung Foundation. Afterwards, feedback on inhalation technique was provided to the child and his/her parent(s). Six weeks later their inhalation technique was reevaluated.

Results: Significantly more children carried out a perfect inhalation technique (67.0% vs. 36.3%, p=<0.001) and significantly less children showed one, two or three errors (31.5% vs. 63.7% p=<0.001) 6 weeks after instruction. Significantly more children failed to shake their inhaler 6 weeks after instruction (16.9% vs. 6.6%, p=0.035).

Conclusion: Although we observed a significant improvement in inhalation technique six weeks after instruction with tailored feedback, more young asthmatic children failed to shake their inhaler. We recommend that reinforcement on essential steps that are performed correctly should be highly emphasized.