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Evaluating
Children's Technique with MDIs
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Nursing researchers
studied elementary children's use of metered-dose inhalers (MDIs) for
asthma medications using a pre- and post-intervention evaluation. The
study described how accurately children used their own inhalers, identified
common self-administration errors, and evaluated whether instruction led
to fewer errors. Forty-two children with persistent asthma (mean age 9.6
years, range 7 through 11 years) participated in a five-week trial of
nurse-led asthma education. They had experienced asthma for an average
of 4.7 years, and all had prescribed medications. Their parents reported
the asthma to be in good or very good control; none of the children had
been hospitalized for asthma. Six students did not bring their medication
to at least two sessions and were not included in the MDI-technique study
within the educational program.
Six steps were used as the criteria for proper MDI technique: shake canister
before use, coordinate inhaler activation and inspiration, inhale deeply,
hold breath between actuations, shake canister before second actuation,
use spacer if appropriate for the inhaler type. Each child demonstrated
how he/she used his own MDI at home using a placebo canister. After the
child's demonstration, the nurse reviewed and corrected any technique
errors. The assessment was repeated one to four weeks later.
Most (92%) had at least one error at the baseline assessment, but following
the educational intervention only 7 (19%) did not have a perfect score.
The most frequent errors at baseline were: not holding breath after actuation
(56%), not waiting at least a full minute between breaths (50%), not shaking
the canister adequately (42%), not breathing deeply (42%), and not using
a spacer when indicated (22%).
Even with direct
instruction, nearly one-fifth of the children in this study made at least
one error. Clinicians should assess patients' MDI use techniques at every
health care visit and correct any technique errors. Patients should be
given handouts that describe proper technique instruction to use as a
review or self-check list.
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