Comprehensive teaching of inhaler technique in asthmatic children and its association with ED visits and hospitalizations due to asthma

• Restricted to UC San Diego use only

• 2012

• Tsang, Terri (Ruey-Shiuan)

Background : Asthma exacerbations are the number one avoidable pediatric hospitalizations in the US. It is well -established that many children (29-67%) use their metered -dose inhalers (MDI's) incorrectly. Further, it has been shown that proper inhaler technique is associated with how the child was taught to use his/her inhaler. Specifically, children who were 1) demonstrated inhaler technique 2) asked to demonstrate it back at the initial instruction session and 3) further received instruction at subsequent visits were more likely to demonstrate correct inhalation technique. The association between such "comprehensive" instruction and disease outcomes, such as ED visits and hospitalizations, has not yet been thoroughly examined. Hypothesis Children who were "comprehensively" taught proper MDI technique have fewer ED visits and hospitalizations. Methods : Study subjects were recruited from children who presented to the pediatric emergency department for any reason. Only children with an established diagnosis of asthma and previously treated with an MDI were approached for the study. A questionnaire was completed regarding details of previous MDI instruction then assigned a "comprehensiveness" score. The questionnaire also addressed previous steroid administration, ED visits and hospitalizations for asthma. These represent the "outcomes" following whatever MDI instruction they had already received. The child and family were also asked to demonstrate their inhaler technique, which was scored using a previously validated scoring system, and designated as correct vs. incorrect based on their score. Children were stratified based on teaching comprehensiveness and analyzed for against actual MDI technique as well as against various asthma outcomes. Results : 84 children have been enrolled in the study thus far. Children with a "comprehensive" teaching score, satisfying all 3 criteria mentioned above, were more likely to have persistent as opposed to intermittent asthma (73% vs. 41%, p=0.004) and use a controller medication (67% vs. 33 %, p=0.003). Children with comprehensive teaching were not shown to have statistically significant differences in technique scores, ED visits or hospitalizations. While not statistically significant, children with comprehensive teaching did tend to have a higher proportion of children who demonstrated correct technique (57% vs. 37%, p=0.082). Surprisingly, they also tended to have more ED visits within the past year (67% vs. 59%, p= 0.46) and a higher mean number of ED visits (1.73 ± 1.37 vs. 1.20 ± 1.25, p=0.10). However, among children with comprehensive teaching who had been to the ED, fewer of these children had unnecessary ED visits compared to children with less comprehensive teaching (35% vs. 48%, p=0.346). Conclusion : Most of the associations presented thus far are not statistically significant, possibly due to the small sample size. None the less, as previously shown, children who had received "comprehensive" teaching were more likely to demonstrate proper inhaler technique. However, it seems that children with more comprehensive teaching do not have better out comes in terms of ED visits and hospitalizations, and if anything, seem to demonstrate more , not less ED utilization. This may suggest that more teaching occurs for kids with more severe asthma and more often in emergency settings than preventive settings. This study hopefully helps makes a stronger case for further research in this area and the need to improve and standardize how children are taught to use their inhalers, especially in the outpatient setting, in order to effectively manage pediatric asthma and prevent ED and hospital visits

1 online resource (13 p.)

• Academic Dissertations

• Dissertations, Academic--School of Medicine. (Discipline)--UCSD

• text

Thesis (M.D.)--University of California, San Diego, 2012

Forms part of the UCSD School of Medicine independent study projects, Class of 2012

Includes bibliographical references (p. 13)

• Terri (Ruey-Shiuan) Tsang

Under copyright (US)

Use: This work is available from the UC San Diego Libraries. This digital copy of the work is intended to support research, teaching, and private study.

Constraint(s) on Use: This work is protected by the U.S. Copyright Law (Title 17, U.S.C.). Use of this work beyond that allowed by "fair use" requires written permission of the copyright holder(s). Responsibility for obtaining permissions and any use and distribution of this work rests exclusively with the user and not the UC San Diego Library. Inquiries can be made to the UC San Diego Library program having custody of the work.

Academic Liaison Program, University of California, San Diego, La Jolla, 92093-0175 (http://ucsd.libguides.com/c.php?g=91092&p=584168)

2020-10-22