Evaluation of inhaler use technique in a pediatric appointment

ORIGINAL ARTICLE

Evaluation of inhaler use technique in a pediatric appointment

Joana Cleto Duarte da Costa Ribeiro, Carolina dos Santos Folques Alves, Maria Manuel Zarcos.

Department of Pediatrics, Centro Hospitalar de Leiria, Leiria, Portugal.

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Abstract
Introduction: Inhalers are recommended for asthma prophylactic and crisis therapy. In order to have a good deposition of drugs at pulmonary tissue, the correct use of the devices is necessary.
Objective: To verify the inhaler use technique with pressurized metered-dose inhalers (pMDIs) with spacers and dry-powder inhalers (DPIs) in a pediatric sample (ages between 1 and 17 years old).
Material and Methods: Descriptive, observational and cross-sectional study. Application of a checklist that included the steps of the correct inhaler use technique, which was performed under physician observation, and other questions related to the use of the devices.
Results: We observed a total of 83 inhaler use techniques: 46 pMDIs with spacers and 37 DPIs. About 54% of pMDIs with spacers users and 27% of DPIs users performed the inhaler use technique correctly, p=0.012. The most frequent mistakes in pMDIs with spacers users were: 50% didn’t waste the first puff, 17.4% didn't shake the device prior to use and 28.3% didn’t wait between inhalations. The mistakes observed in DPIs users were: 43.2% didn't perform a forced expiration before inhaler use, 13.5% didn’t start with a forced inspiration, 24.3% didn't pause at the end of inspiration, 32.4% didn’t exhale slowly and 35.1% didn't wait between inhalations.
Conclusion: Multiple mistakes were observed even in the users who had been followed up for several years. The most frequent mistakes occurred in DPIs users. Thus, the inhaler use technique must always be observed by the physician in all appointments, especially in users of DPIs in which the correct use depends on their autonomy.

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