Impact of educational intervention for correct inhaler technique on the quality of life of children with asthma

Slavica  Konević; Nela Djonović; Dušan Djurić; Ljiljana  Marković-Denić; Dobrila Vasić; Jelena Martinović

doi:10.2298/VSP180815036K

Slavica Konević Community Health Center Rakovica, Department of Specialist Consultancy Services, Belgrade, Serbia
Nela Djonović University of Kragujevac, Faculty of Medical Sciences, Department of Hygiene and Ecology, Kragujevac, Serbia
Dušan Djurić University of Kragujevac, Faculty of Medical Sciences, Department of Clinical Pharmacy, Kragujevac, Serbia
Ljiljana Marković-Denić University of Belgrade, Faculty of Medicine, Institute of Epidemiology, Belgrade, Serbia
Dobrila Vasić Community Health Center Rakovica, Department of General Medicine, Belgrade, Serbia
Jelena Martinović Community Health Center Rakovica, Laboratory Department, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP180815036K

Keywords: asthma, child, nebulizers and vaporizers, quality of life, education, medical, respiratory function tests

Abstract

Background/Aim. Asthma is the most common chronic disease in children and adolescents and has shown an apparent increase in incidence in recent years. The first purpose of the study was to evaluate the influence of education about proper use of inhalers on quality of life in children with asthma. Secondly, we aimed to understand which aspects of quality of life in children with asthma can be significantly improved after education and to identify factors that may affect the level of that improvement. Methods. In this prospective, before-and-after interventional study, a total of 147 children with asthma were enrolled. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to measure the functional problems that are most troublesome to children with asthma. We used the Asthma Control Test (ACT), based on a series of question about symptoms and daily functioning, to identify patients with poorly controlled asthma. Forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were also determined. Trained educators estimated patients’ inhaler technique and collected questionnaire information. Results. Multivariate analysis of covariance indicated significant differences between PAQLQ and ACT scores which all were significantly higher after education about proper use of inhalers (p < 0.001). A number of children demonstrating a correct inhalation technique improved from 28 (19%) to 127 (86.4%) (p < 0.001). Asthma severity accounted for the largest proportion of variability PAQLQ and ACT scores (38.4%). Conclusion. Inhaler technique improvement contributes to better asthma control in children with asthma rather than to their quality of life. Asthma severity proved to be a major contributor to variations in PAQLQ and ACT scores and significant obstacle for quality of life improvement in children with asthma.

References

Sears MR. Trends in the prevalence of asthma. Chest 2014; 145(2): 219–25.

Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J 2015; 46(3): 622–39.

Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Götz M et al. The European Pediatric Asthma Group. Diagno-sis and treatment of asthma in childhood: a PRACTCALL consensus report. Allergy 2008; 63(1): 5–34.

Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern J, Lemanske R et al. International consensus on (ICON) pediat-ric asthma. Allergy 2011; 67(8): 976–97.

Sleath B, Ayala GX, Gillette C, Williams D, Davis S, Tudor G, et al. Provider demonstration and assessment of child device technique during pediatric asthma visits. Pediatrics 2011; 127(4): 642–8.

Stein SW, Thiel CG. The history of therapeutic aerosols: a chronological review. J Aerosol Med Pulm Drug Deliv 2017; 30(1): 20–41.

Levy ML, Hardwell A, McKnight E, Holmes J. Asthma patients' inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the global initiative for asthma (GINA) strategy: a retrospective analysis. Prim Care Respir J 2013; 22(4): 406–11.

Rau JL. The inhalation of drugs: advantages and problems. Respir Care 2005; 50(3): 367–82.

Capanoglu M, Dibek Misirlioglu E, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asth-ma using metered dose or dry powder inhalers. J Asthma 2015; 52(8): 838–45.

Hasegawa K, Bittner JC, Nonas SA, Stoll SJ, Watase T, Gabriel S, et al. Multicenter Airway Research Collaboration-37 Investi-gators. Children and adults with frequent hospitalizations for asthma exacerbation, 2012-2013: a multicenter observational study. J Allergy ClinImmunol Pract 2015; 3(5): 751–8.

Sheares BJ, Mellins RB, Dimango E, Serebrisky D, Zhang Y, Bye MR, et al. Do patients of subspecialist physicians benefit from written asthma action plans? Am J Respir Crit Care Med 2015; 191(12): 1374–83.

Boulet LP, Boulay MÈ, Gauthier G, Battisti L, Chabot V, Beauch-esne MF, et al. Benefits of an asthma education program pro-vided at primary care sites on asthma outcomes. Respir Med 2015; 109(8): 991–1000.

Cerović S, Zivković Z, Milenković B, Stojanović JJ, Bajec AO, Vukaŝinović Z, et al. The Serbian version of the pediatric asth-ma quality of life questionnaire in daily practice. J Asthma 2009; 46(9): 936–9.

Rottier BL, Eber E, Hedlin G, Turner S, Wooler E, Mantzourani E et al. Monitoring asthma in childhood: management-related issues. Eur Respir Rev 2015; 24(136): 194–203.

Smit HA, Pinart M, Antó JM, Keil T, Bousquet J, Carlsen KH et al. Childhood asthma prediction models: a systematic review. Lancet Respir Med 2015; 3(12): 973–84.

Tilly-Gratton A, Nadon MA, Houle A, Pelaez S, Ducharme FM. What convinces parents of children with asthma to adhere to maintenance inhaled corticosteroids? Canadian J Respir Crit Care Sleep Med 2018; (2)3: 1–8.

Sharifi L, Pourpak Z, Fazlollahi MR, Bokaie S, Moezzi HR, Kazemnejad A, et al. Asthma Economic Costs in Adult Asth-matic Patients in Tehran, Iran. Iran J Public Health 2015; 44(9): 1212–8.

Shealy KM, Paradiso VC, Slimmer ML, Campbell DL, Threatt TB. Evaluation of the prevalence and effectiveness of educa-tion on metered-dose inhaler technique. Respir Care 2017; 62(7): 882–7.

Park HJ, Byun MK, Kwon JW, Kim WK, Nahm DH, Lee MG, et al. Video education versus face-to-face education on inhaler technique for patients with well-controlled or partly-controlled asthma: A phase IV, open-label, non-inferiority, multicenter, randomized, controlled trial. PloS One 2018; 13(8): e019735

Bosnic-Anticevich S, Callan C, Chrystyn H, Lavorini F, Nikolaou V, Kritikos V, et al. Inhaler technique mastery and mainte-nance in healthcare professionals trained on different devices. J Asthma 2018; 55(1): 79–88.

Barbara S, Kritikos V, Bosnic-Anticevich S. Inhaler technique: does age matter? A systematic review. Eur Respir Rev 2017; 26(146): pii: 170055.

Borrell LN, Nguyen EA, Roth LA, Oh SS, Tcheurekdjian H, Sen S et al. Childhood obesity and asthma control in the GALA II and SAGE II studies. Am J Respir Crit Care Med 2013; 187(7): 697–702.

Mitchell SJ, Bilderback AL, Okelo SO. Feasibility of picture-based asthma medication plans in urban pediatric outpatient clinics. Pediatr Allergy Immunol Pulmonol 2016; 29(2): 95–9.

Hashmi A, Soomro JA, Memon A, Soomro TK. Incorrect inhaler technique compromising quality of life of asthmatic patients. J Med 2012; 13(1): 16–21.

Chogtu B, Holla S, Magazine R, Kamath A. Evaluation of rela-tionship of inhaler technique with asthma control and quality of life. Indian J Pharmacol 2017; 49(1):110–5.

Harris KM, Kneale D, Lasserson T, McDonald V, Thomas J, Grigg J. School-based self-management educational interventions for asthma in children and adolescents: A systematic review. J Al-lergy Clin Immunol 2018; 141(2 Suppl): AB207.