Adequate use of asthma inhalation medication in children: more involvement of the parents seems useful

Five general practices selected all children aged 0 to 12 years on asthma inhalation medication. Children demonstrated inhaler use and were interviewed with their parents.46 subjects were enrolled; mean age 5.5 years (SD 3.4) years; 26 (57%) were boys. Of the children using one inhaler only, 70% used the inhaler as indicated and of those using more than one inhaler 46%. On average 2.6 mistakes were made during demonstration of the technique, and 2 mistakes were reported in the interview. In total, 87% of the parents decided when and how the inhaler had to be used. Spacer cleaning was performed correctly by 49%; 26% reported a correct way of assessing how many doses were remaining.Dutch children make essential mistakes related to inhaler use that are easy to avoid. We recommend a better explanation and demonstration of the technique, and recommend involvement of the parents during instruction.Asthma and other chronic airway diseases can be effectively treated by inhaler therapy [1]. Inhaler devices come in a variety of types, such as metered dose inhalers (MDI) or dry powder inhalers (DPI). Irrespective of the type of inhaler device used, the outcome of inhaler therapy largely depends on appropriate use of the inhaler.Appropriate use primarily involves the correct inhalation technique. A poor inhalation technique reduces drug deposition in the lungs [2]; moreover, the more mistakes made in the inhalation technique the lower the beneficial effect on lung function [3]. From adults it is known that 89% of the patients make at least one mistake in the inhalation technique [4]. Also children face difficulties in using an inhaler. A study among Taiwanese children showed that none of the children had a perfect inhalation technique [5], a Dutch study reported that even after instructing children the overall inhalation technique remained poor [6]. In contrast, a study from Malta showed that only 17% of children using an MDI with a spacer device had a poor technique [7].Approp