Chicago—The inhalers pharmacists dispense to children with severe asthma might be used incorrectly at least half of the time, a new study suggests.

The article in the Journal of Hospital Medicine discussed results of a study to evaluate inhaler technique in children hospitalized for asthma. That’s the group at highest risk for complications and death from asthma, point out researchers from the Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine.

Yet the study team reveals that nearly half of participants demonstrated improper inhaler use, which kept them from receiving the full dose of medication.

Especially prone to problems were adolescents, who most commonly displayed critical errors in inhaler technique and also often skipped using a spacer to help the correct amount of medication reach the lungs.

“We know that asthma can be well managed in the majority of patients and using your inhaler correctly is key factor to managing asthma,” explained lead author Waheeda Samady, MD, hospitalist at the children’s hospital and assistant professor of pediatrics at Feinberg. “Improper inhaler technique can contribute to children having uncontrolled asthma and needing to come to the hospital for their asthma. Our study suggests that as healthcare providers we can do a better job showing patients and families the correct inhaler and spacer technique, and checking it frequently to ensure they master it.”

The cross-sectional study was conducted at a tertiary hospital for children, focusing on those aged 2 to16 years who had been admitted for an asthma exacerbation. Researchers analyzed inhaler techniques.

Results indicate that, of 113 participants enrolled, 55% had uncontrolled asthma and 42% missed a critical step in inhaler technique.

Researchers determined that more patients missed a critical step when they used a spacer with mouthpiece instead of a spacer with mask (75% [51%-90%] vs. 36% [27%-46%]) and were older (age 7.8 [6.7-8.9] vs. age 5.8 [5.1-6.5] years).

In fact, they note that patients using the spacer with mouthpiece remained significantly more likely to miss a critical step when adjusting for other clinical covariates (odds ratio 6.95 [1.71-28.23], P = .007).

“Hospital-based education may provide teachable moments to address poor proficiency, especially for older children using a mouthpiece,” study authors advise.

“We see that our adolescent patients, who are transitioning to independent medication management, still need close monitoring to make sure they use their inhaler and spacer appropriately to achieve optimal asthma control,” Samady said. “Teens may feel that using a spacer is only for younger children, but using a spacer is recommended for adults as well.”

Previous studies have shown that adding a spacer device to an inhaler increases the amount of asthma medication a person takes in from 34% to 83%, the article notes.

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