Improvement of metered-dose inhaler administration technique: The effect of training sessions at a specialized pediatric asthma compliance and technique clinic

Background: Metered-dose inhaler (MDI) medications are frequently prescribed for the management of asthma in children. Because the use of inhalers can be difficult, many children with asthma fail to use their MDI correctly. Objective: The purpose of this study was to determine whether a specialized Pediatric Asthma Compliance and Technique (PACT) clinic could be effective in improving techniques for MDI use among children with asthma. Methods: Children referred to the PACT clinic underwent pulmonary testing and were asked to demonstrate their MDI technique at an initial coaching session. Clinicians at the PACT clinic demonstrated and reviewed correct techniques for MDI use and asked the children to demonstrate the technique again. Follow-up visits of at least 1/2 hour were scheduled according to the patient's asthma severity. Results: Of the 40 children referred to the PACT clinic, 26 were using an MDI at the time of their initial clinic assessment. Only 12% (3/26) were able to perform all 8 steps for MDI administration correctly (median 4 of 8 steps performed correctly without prompting). After the first coaching session, patients were followed up an average of 2.4 months later, with 31% (8/26) performing all 8 steps correctly. On average, children were able to perform 7 of 8 steps correctly without prompting. When the data were analyzed by step, statistically significant improvements were noted on 5 specific steps. Conclusions: The proper use of the MDI is crucial for the delivery of many asthma medications. The results of this study suggest that children need intensive education before they can learn and remember how to use their MDI correctly. One intensive coaching session on correct use of MDIs dramatically improved technique at follow-up in this inner-city medical clinic.