Current National Heart, Lung, and Blood Institute recommendations for the treatment of asthma include the use of metered-dose inhalers (MDIs) to deliver short-acting bronchodilators for rescue medication and the use of peak flow meters (PFMs) to determine the degree of illness and assist in establishing treatment plans. Currently, there are insufficient studies to determine if children with acute asthma exacerbations properly use MDIs and PFMs as recommended by the national guidelines. In addition, there are no studies that determine which factors predict poor technique. Scarfone and associates studied the ability of children and adolescents with acute asthma exacerbations to adhere to the national guidelines for proper use of MDIs and PFMs. In addition, they studied the characteristics that were associated with improper use.

The participants of this prospective study were children and adolescents who presented to an emergency department in an urban tertiary care center with an acute exacerbation of asthma. When seen in the emergency department, the children and adolescents were instructed to use a placebo MDI or PFM exactly as they did when at home. Research assistants who were trained in the use of MDIs and PFMs observed their technique. Patients who had used a holding chamber before presenting to the emergency department were provided with a placebo MDI with a holding chamber. The assistants observed each patient’s technique and graded it on the basis of the performance of specific steps recommended by the national guidelines.

In this study, 45 percent of the children and adolescents who used an MDI demonstrated multiple steps improperly. A similar percentage of those who used a holding chamber demonstrated improper use. Predictors of inappropriate technique with the MDI were younger ages in patients and parents. The predictors of poor technique in those using an MDI with a holding chamber included no hospitalization within the past year, parental assistance with the device, and nondaily use of the device. Almost 83 percent of the participants who should have been using PFMs at home did not. Of those who did use a PFM at home, nearly 74 percent used the device correctly.

The authors conclude that a significant number of children and adolescents with acute asthma are not performing with proper technique when using MDIs. In addition, despite the fact that national guidelines recommend the use of PFMs in the management of asthma, a substantial number of children and adolescents were not using these devices. The authors add that a greater emphasis should be placed on teaching appropriate techniques for MDI use and on instructing patients about the importance of self-monitoring their disease with PFMs.