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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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