Tips for Teaching Your Child Proper Inhaler Technique

Asthma inhalers are one of the most effective tools for achieving and maintaining steady asthma control. The medicine they deliver is important, even in the presence of triggers and irritants. Unfortunately, one of the most common reasons why they don't work well is because we don't use the right inhaler technique.¹

Using an asthma inhaler properly can be especially challenging for children.² This issue can be helped when kids use spacers with their inhalers. However, proper technique is still crucial.

Proper inhaler technique is essential

The National Asthma Council in Australia emphasizes that:¹

• Not using the correct inhaler technique can raise the risk of severe flare-ups and emergency care
• The lack of asthma symptom control is often linked to poor inhaler technique
• Incorrect inhaler technique when using inhaled steroids makes side-effects like dysphonia and oral thrush more likely

Unfortunately, when doctors prescribe an inhaler, there are often no provisions made to actually teach the patient how to use it correctly. I know that no one has ever offered to show me. Nor did the pediatrician or his staff educate my daughter or grandson when he was recently switched from a nebulizer to inhaler and spacer.

Also, the steps for using an inhaler device often differ slightly between various brands. So, if medications are being switched in order to find the best treatment plan, this education of correct technique may need to be repeated each time.

This issue is important because when health care professionals check and correct patient inhaler techniques, it can improve asthma outcomes.²

Does your child know the proper inhaler technique?

How do you know if you or your child are using the right inhaler technique? Most package inserts that come with a prescription medicine do include some instructions. So that's a great place to start. Videos can also be found on the Web that will help you learn. Here are a few I found with a quick search:

• Centers for Disease Control (with and without a spacer; English & Spanish)³
• About Kids Health⁴
• Nationwide Children's⁵

It's a great idea to demonstrate your technique or have your child do so whenever you visit the doctor. This is true even if you've been using your inhaler for years. Make sure you show your health care team how you use your inhaler from time to time. They can offer pointers and tips to improve your technique, or your child's.

Details of a recent study

A recent study that was published in the Journal of Hospital Medicine, observed inhaler technique in a group of children who were hospitalized for asthma.⁶ What they found was that almost half the children studied weren't using correct inhaler technique. As a result, they weren't getting the full dose of their asthma medicine. And that probably led to their need for hospitalization.

Here are the details of the study:⁶

• 113 children, aged 2 to 16 years were observed using their inhalers
• 55% of the children studied were found to have uncontrolled asthma
• 42% missed a critical step in the inhaler technique
• 75% of the kids using an inhaler only with a mouthpiece, rather than a spacer, missed a step

One of the steps most often missed was priming the device before the first dose. (Priming is also needed after a few days of not using a quick relief inhaler.)

Interestingly, the teens in the study were making more mistakes in inhaler technique than younger children. One issue is that teenagers (and other age kids as well) were not always using a spacer. Spacers have been proven to increase the amount of medication delivered by 34 percent to 83 percent!⁷ But teens seem to view spacers as something only young children needed.

In summary

Whether the patient is an adult, teenager, or younger child, proper inhaler technique is an important tool in asthma control. Spacers can be a helper with this, decreasing the potential for mistakes in technique.  Even adults can benefit from using a spacer!

When was the last time you had your child's doctor observe their inhaler technique?