11:36pm Thursday 04 June 2020

Kids with asthma need more help with inhalers, study shows

While children have more success with newer inhaler designs, at best only one child in four gets it completely right, according to the findings published online March 28, 2011, 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 are estimated at $1 billion a year.

Researchers led by Betsy Sleath, Ph.D., at the UNC Eshelman School of Pharmacy studied 296 North Carolina patients aged 8 to 16 years old 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 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 (41 providers at five clinics) did not demonstrate or assess children’s use of the four devices 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 said. “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 said.

Previous studies have noted the need for providers to demonstrate and make sure children understand proper techniques for using asthma medication and monitoring devices. In 2007, a National Heart, Lung and Blood Institute expert panel report on the diagnosis and management of asthma encouraged providers to educate children on these techniques.

Sleath is the George H. Cocolas Distinguished Professor and chair of the School’s pharmaceutical outcomes and policy division. UNC study co-authors are Stephanie Davis, M.D., associate professor in pediatrics in the School of Medicine; Karin Yeatts, Ph.D., research assistant professor in the Gillings School of Global Public Health; and associate professor Dennis Williams, Pharm.D., and graduate students Chris Gillette and Deidre Washington of the pharmacy school. Additional co-authors are Guadalupe X. Ayala, Ph.D., associate professor in the Graduate School of Public Health at San Diego State University, and Gail Tudor, Ph.D., professor and director of institutional research at Husson University in Bangor, Maine.

The study, titled “Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits,” was funded by the National Heart Lung and Blood Institute. The project was also supported in part by a grant from the National Center of Research Resources, National Institutes of Health.

Media note: For a copy of the study, please contact the journal’s media office at (847) 434-7877 or

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