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Demonstrated Use of Metered-Dose Inhalers and Peak Flow Meters by Children and Adolescents With Acute Asthma Exacerbations
Richard J. Scarfone, MD;
Geoffrey A. Capraro, MD;
Joseph J. Zorc, MD;
Huaqing Zhao, MA
Arch Pediatr Adolesc Med. 2002;156:378-383.
Objectives To determine the ability of children and adolescents with acute asthma
exacerbations to adhere to national guidelines for proper metered-dose inhaler
(MDI) 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 MDI 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 underuse. 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.
From the Departments of Pediatrics (Drs Scarfone and Zorc) and Biostatistics
and Epidemiology (Mr Zhao), University of Pennsylvania School of Medicine,
and the Division of Emergency Medicine, The Children's Hospital of Philadelphia,
(Drs Scarfone and Zorc), Philadelphia; and the Department of Pediatrics, Boston
University School of Medicine, and the Division of Pediatric Emergency Medicine,
Boston Medical Center, Boston, Mass (Dr Capraro).
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