Less than one in ten children with asthma use traditional inhalers correctly, according to a new study from the University of North Carolina at Chapel Hill.

And while children have more success when equipped with newer inhaler designs, at best only one child in four gets it completely right, according to the findings published online in the journal Pediatrics.

Asthma is the most common chronic condition among American children. Related health-care costs are estimated at more than $6 billion a year, and lost productivity costs associated with working parents caring for children who miss school is estimated at $1 billion a year.

Researchers led by Betsy Sleath, PhD, at the UNC Eshelman School of Pharmacy studied 296 North Carolina patients age eight to sixteen who used four different devices to manage their asthma. The devices were

• the metered-dose inhaler (commonly called a puffer);
• the diskus, a dry-powder inhaler delivering Advair;
• the turbuhaler, a dry-powder inhaler delivering Pulimcort or Symbicort; and
• the peak-flow meter, which does not deliver a drug but is instead used to measure lung function to determine if medicine is needed.

Only 8.1 percent of children in the study performed all of the metered-dose inhaler steps correctly. Older children were more likely than younger children to get more of the metered-dose inhaler steps correct. With a diskus, 21.9 percent of children performed all steps correctly, and 15.6 percent performed all of the turbuhaler steps correctly. Children using a peak-flow meter did so correctly 23.9 percent of the time.

The researchers also found that the majority of health-care providers who participated in the study (forty-one providers at five clinics) did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.

“It is crucial that health-care providers not only show a child how to use an inhaler correctly but also have the child demonstrate the device in front of a physician or pharmacist,” Sleath says. “Pediatric practices are extremely busy places so we need innovative ways to demonstrate and assess device technique among asthmatic children.”

Improper use of inhalers and other asthma medication devices can lead to poor control of the condition, more hospitalizations, and increased health-care costs, she says.

Previous studies have noted the need for providers to demonstrate proper asthma medication and monitoring device techniques to children and to have children demonstrate to proficiency. The 2007 National Heart, Lung, and Blood Institute expert panel report on the diagnosis and management of asthma encourages providers to educate children on these techniques.

Sleath is the George H. Cocolas Distinguished Professor at the pharmacy school and the chair of the Division of Pharmaceutical Outcomes and Policy. Her coauthors from UNC-Chapel Hill are Stephanie Davis, MD, associate professor in pediatrics in the UNC School of Medicine; Karin Yeatts, PhD, research assistant professor in the UNC Gillings School of Global Public Health; and associate professor Dennis Williams, PharmD, graduate student Chris Gillette, and former postdoc Deidre Washington, PhD, of the UNC Eshelman School of Pharmacy. Additional coauthors are Guadalupe X. Ayala, PhD, MPH, associate professor in the Graduate School of Public Health at San Diego State University, and Gail Tudor, PhD, professor and director of institutional research at Husson University in Bangor, Maine.

This project was funded by the National Heart Lung and Blood Institute (grant HL069837). The project was also supported in part by grant UL 1RR025747 from the National Center of Research Resources, NIH.