Prevalence and Risk Factors of Incorrect Inhaler Technique in Asthmatic Children at Faculty of Medicine Vajira Hospital
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Abstract
Introduction: Diagnosis of asthma has been increasing among young children. The inhaled corticosteroids can reduce the risk of asthmatic attack. The effectiveness of inhaled corticosteroids depends on the appropriate and regular use of inhaled corticosteroids. Improper methods of use of inhaled corticosteroids can lead to suboptimal dosage and unsatisfactory control. The correct use lies on the skills of the affected children as well as their caregivers. This cross-sectional study was to assess the prevalence of and factors associated with incorrect use of inhaled corticosteroids in children with asthma and their caregivers.
Methods: Pediatric patients aged 1-15 years old who were having their treatment for asthma with inhaled corticosteroids in our institution during March 1, 2017 to August 31, 2017 were included. Data were collected by an interview the patients and/or their caregivers according to the prepared questionnaire. The demonstration of metered dose inhalation (MDI) procedure using spacer and no spacer by the patients or caregivers was assessed.
Results: Among 85 children aged 1–15 years who were receiving corticosteroids through MDI with (n=76) and without (n=9) spacers. The inhalers were used incorrectly in 51 children (60%). The most frequent incorrect method was breathing normally 5-6 times via spacer in the spacer group (27 children, 35.5%) whereas inappropriate placing of the mouthpiece or a 30-second interval between puffs were found in the no-spacer group (2 children in each step, 22% each). Risk factors for the incorrect use were non-maternal primary caregivers. Having fathers and other caregivers as supervisors increased the risk of incorrect use for 5.50 times [95% confidence interval (CI), 1.12–25.50, p = 0.034] and 6.38 times (95%CI, 1.47–26.62, p = 0.009) respectively higher than having mothers as the supervisors. Incorrect use was found 7.20 times (95% CI, 2.31–21.40, p = 0.001) more likely in children with prior acute asthma exacerbation and 5.55 times (95%CI 1.02–28.54, p = 0.047) among children and caregivers who did not understand and failed to clarify the procedures with the instructor during the hospital teaching class.
Conclusion: Incorrect corticosteroid inhalation was found in 60% and was directly correlated with hospital admission from acute exacerbation. Important factors related to incorrect use were the primary caregivers being children’s non-maternal and difficulty in learning during the hospital-teaching class.
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