Assessment of correctness of inhalation technique among asthmatic children and Their caretakers at the Kenyatta national Hospital

Abstract

Background: Asthma is a major cause of morbidity among children throughout the world and it is currently estimated to affect more than 300 million people. Its diagnosis is mainly clinical based on history although it can be confirmed in the older child by doing lung function tests. Treatment is by use of inhaled controller and reliever medications using a step up and step down approach. Correct inhalation technique is necessary for the effectiveness of asthma medications. Study design: This was a cross-sectional descriptive study done at the Kenyatta National Hospital (KNH) among asthmatic children aged 6 months to 12 years and their caretakers. Study objectives: Th'e purpose of this study was to evaluate the correctness of use of pressurised metered dose inhalers and spacer devices, to determine the common errors in the inhalation technique and factors associated with incorrect technique. Data analysis: The data was analyzed using statistical package for social sciences (SPSS) version 17.0. Comparison of proportions and medians was done. Chi square test was used to analyse categorical variables while we used student t-test for continuous variables. Results: Eighty two subjects were recruited into the study and assessed for correctness of inhalation technique. Of these, 46 (56.1 %) were males and the median age for the subjects was 45 (range 9-155) months. Among these, 74 (90.2%) were administered inhaler medications by the caretaker and the technique assessment was deemed to be that of the respective caretaker. Of the 82 subjects, only 37 (45.1%) performed all the essential steps ofthe inhalation technique correctly. The two leading errors were not taking adequate breaths after actuation of inhaler, observed in 34 (44.7%) of76 subjects and not shaking the inhaler before use, recorded in 15 (18.3%) of all the 82 subjects. The sociodemographic characteristics of correct and incorrect performers (age, sex, residence, income level, level of education) and the clinical characteristics (duration since asthma was diagnosed, duration of inhaler medications use) were mainly found to be similar. 'Conclusion: A majority (55%) of asthmatic children and their caretakers do not perform the inhalation technique correctly. The commonest errors in inhalation technique are failure to take adequate breaths after actuation of inhaler (45%) and not shaking the inhaler before use (18%). The characteristics of correct and incorrect users are mainly similar. Recommendations: All caretakers of asthmatic children on inhaler medications and the older children should be trained on appropriate inhalation technique. Study utility: Inappropriate inhalation technique reduces lung deposition of asthma ) aerosol drugs and therefore leads to poor asthma control and asthma instability. It has also been associated with increased adverse effects like oropharyngeal candidiasis. Identifying the common errors in the technique will go a long way in improving better use of inhalers and thus improve asthma control and reduce those adverse effects once the errors are addressed