Development of a scale to measure children's metered-dose inhaler and spacer technique

Abstract

Background: A measure of metered dose inhaler (MDI) and spacer technique would help health care providers to estimate the degree to which technique may confound clinical efficacy of inhaled medications.

Objective: Our purpose was to extend earlier efforts to develop a rating scale to assess the accuracy of children's technique in using an MDI with three of the newer spacer devices.

Methods: Subjects were children, 7 to 17 years old, with moderate to severe asthma attending a follow-up appointment in an outpatient specialty clinic for asthma. Nurse practitioners and/or physicians completed a rating scale (MDI Check-list) for 50 children using an Optihaler spacer, 29 using Azmacort, and 21 using InspirEase.

Results: Depending on the spacer used, 14% to 26% of the children failed to demonstrate the critical skills for delivering medicine to the conducting airways, with the InspirEase group showing the best results. Items vary in difficulty (percent correct). The scale has excellent internal consistency reliability for Optihaler.

Conclusions: The scale can be used (1) by health care providers to instruct patients or colleagues, (2) by parents to monitor and correct their children's MDI/spacer technique, and (3) by researchers to estimate drug delivery in studies of clinical outcome or adherence.