Pediatric providers rarely demonstrate proper use of asthma devices

Many children don’t know how to properly use asthma devices, and not enough providers are demonstrating correct use of these devices or assessing how children use them during pediatric asthma visits.

Researchers studied use of metered dose inhalers (MDIs), turbuhalers, diskuses, and peak flow meters (PFMs) in 296 children aged 8 to 16 years with asthma. They also investigated whether providers assessed how children used the devices and whether providers demonstrated their proper use during visits. Among the children, 270 used MDIs, 105 diskus devices, 45 turbuhalers, and 67 PFMs.

Just over 8% of children could correctly perform all MDI steps. Twenty-two percent of children could correctly use diskus devices, 15.6% turbuhalers, and 24% PFMs. With MDIs and diskus devices, children most frequently missed exhaling normally before using the devices and holding their breath for 10 or more seconds afterward.

Providers asked few children to demonstrate how they used their asthma devices. Only 5.4% of children using MDIs were asked to demonstrate their technique; 14.3% of children were asked to demonstrate their use of diskus devices; and less than 5% of children on turbuhalers were asked to demonstrate their proficiency. Providers asked only 2 children to demonstrate their use of PFMs.

In addition, most providers didn’t demonstrate how to properly use asthma devices. Providers demonstrated turbuhaler use for only 1 child and PFM use for 2 children. Only 3.8% and 11.4% of children using MDIs and diskus devices, respectively, had providers demonstrate proper technique during visits.

The more children who are shown how to use devices and have time to practice using them during medical visits and receive feedback from providers, the more opportunity there is to build behavioral capacity and self-efficacy, according to the researchers. These children will be more apt to use their asthma devices properly, which could result in improved health outcomes.

Sleath B, Ayala GX, Gillette C, et al. Provider demonstration and assessment of child device technique during pediatric asthma visits. Pediatrics. 2011;127(4):642-648.