Evaluation of inhaler device technique in caregivers of young children with asthma

Michael J. Welch, Mona L. Martin, Paul V. Williams, Carol L. Gallet, Mary Claire Miller, Antonia V. Bennett, Roxanne W. May, Kathy L. Lampl, Sulabha Ramachandran

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Inhalation therapy has become the primary treatment mode for most pediatric pulmonary diseases. Errors in inhalation technique can decrease intrapulmonary drug deposition, which may lead to a decrease in therapeutic response. This study examined the ability of caregivers of young children with asthma, after being provided careful and standardized instruction, to correctly demonstrate how to use 1 of 2 different inhaler delivery systems. Caregivers of children aged 1-6 years, who were being prescribed an inhaler device for the first time, were trained by a staff asthma educator using a standardized educational checklist. One week later, the caregiver was required to demonstrate the correct preparation, use, and maintenance of their prescribed device to a different staff asthma educator, who rated their performance using the same standardized educational checklist. Errors (total and major) in carrying out the individual steps for each delivery device were recorded, and a Performance Mastery Score (measure of ability to do device steps correctly) was calculated. The total and major error rates were 24.8% and 15.6%, respectively, for the metered-dose inhalers (MDIs) with spacer, and 15.9% and 8.5%, respectively, for the nebulizer (P<0.001). The mean Performance Mastery Score was 84.5% for the MDI with spacer and 91.9% for the nebulizer (P<0.001). Caregivers of young children with asthma demonstrate a number of errors in device use, including major ones that can potentially result in poor lung delivery, even 1 week after standardized training by an asthma educator. Mastery of the MDI with spacer delivery system appears somewhat harder than that seen with the nebulizer. These findings suggest the need for repetition of sessions reinforcing inhalation instructions at follow-up in addition to initial education of proper device use, no matter what type of delivery system is selected.

Original languageEnglish (US)
Pages (from-to)113-120
Number of pages8
JournalPediatric, Allergy, Immunology, and Pulmonology
Issue number2
StatePublished - Jun 1 2010

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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