Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations

Objectives: To determine the ability of children and adolescents with acute asthma exacerbations to adhere to national guidelines for proper metered-dose inhaler (NIDI) and peak flow meter (PFM) technique and to define characteristics associated with improper use. Design: A prospective study in which the patients were instructed to use a placebo MDI or a PFM in the emergency department exactly as at home. Technique was graded on the basis of performance of specific steps recommended by national guidelines. Setting and Participants: Children and adolescents (aged 2-18 years) with acute asthma exacerbations in the emergency department of an urban children's hospital with acute asthma. Results: Thirty-three (45.2%) of 73 patients using an MDI (MDI group) demonstrated multiple steps improperly compared with 60 (44.4%) of 135 using an NIDI with a holding chamber (MDI-HC group P = .92). In the MDI group, young ages of the patients (P < .008) and the parents (P < .003) were associated with improper use. In the MDI-HC group, factors independently and significantly associated with improper use were no hospitalizations within the past year, parent assistance of the patient with MDI-HC use, and nondaily use of the MDI-HC. Also, 165 (82.9%) of 199 children who, per national guidelines, should be using a PFM at home, did not, Eighty-two (73.9%) of 111 patients demonstrated perfect performance of all PFM steps. Conclusions: Among children with acute asthma, we found high rates of improper MDI use and PFM under-use. A greater emphasis must be placed on teaching methods to optimize drug delivery and to instruct patients about the importance of self-monitoring of disease severity.