Inhaler technique among asthmatic children: common errors and impact on asthma control

Abstract

<bold>Introduction:</bold> Ineffective use of inhalers undermines the optimal delivery of medication and therefore is a major cause of uncontrolled asthma. We aimed to assess the common errors in inhaler use in patients and its impact on asthma control. <bold>Methods:</bold> We conducted a cross-sectional study including asthmatic children followed in our department between January 2023 and Mai 2023. Inhaler technique and asthma control were assessed during the clinic visit. To evaluate asthma control we used the asthma control test (ACT) in children over the age of 12 and the childhood ACT (c-ACT) in children under 12 years of age. <bold>Results:</bold> We recruited 112 children. The mean age was 9.0 years ± 3.0 [6-17 years] with a male predominance (gender ratio of 1.5). The most common inhalers used were the pressurized metered dose (pMDI) (92.8 %) followed by dry powder inhalers (DPI) used only in 9 patients. Inhalers with spacers were used by 48.2% of the patients. Inhaler technique was considered incorrect in 22.3% of cases. The most common errors were lack of coordination in 22 patients, not breathing out completely before inhalation in one patient, a spacer too large used in one patient and one patient used the inhaler with its cap inverted. The mean ACT score was 18.5±4.8 and the mean c-ACT score was 19.1±3. Asthma was uncontrolled in 47.3% of cases. Incorrect inhaler technique was associated with uncontrolled asthma (p=0.001). <bold>Conclusion:</bold> Our results highlight that asthma control was poor among incorrect users. It is therefore important to reassess regularly the use of inhalers during follow-up visits in order to improve asthma management.