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J Hosp Med. 2019 Apr 8;14:E1-E5. doi: 10.12788/jhm.3195. [Epub ahead of print]

Critical Errors in Inhaler Technique among Children Hospitalized with Asthma.

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Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Midwestern University, Downers Grove, Illinois.
University of Chicago, Chicago, Illinois.


Past studies have not evaluated inhaler use in hospitalized children with asthma. The objectives of this study were to evaluate inhaler technique in hospitalized pediatric patients with asthma and identify risk factors for improper use. We conducted a prospective cross-sectional study in a tertiary children's hospital for children 2-16 years of age admitted for an asthma exacerbation, and inhaler technique demonstrations were analyzed. Of 113 participants enrolled, 55% had uncontrolled asthma, and 42% missed a critical step in inhaler technique. More patients missed a critical step when they used a spacer with mouthpiece instead of a spacer with mask (75% [51%-90%] vs 36% [27%-46%]) and were older (7.8 [6.7-8.9] vs 5.8 [5.1-6.5] years). Patients using the spacer with mouthpiece remained significantly more likely to miss a critical step when adjusting for other clinical covariates (odds ratio 6.95 [1.71-28.23], P = .007). Hospital-based education may provide teachable moments to address poor proficiency, especially for older children using a mouthpiece.


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