Asthma Study Cites Misuse of Inhalers

Tuesday, July 14, 2009

A new study shows that some adults in low-income neighborhoods may not be administering inhaled asthma medicines correctly to children in their care. The problem occurs in all socioeconomic groups, says Stephen J. Teach, head of the asthma education program at Children's National Medical Center in Washington. "Using inhalers requires some choreographed breathing and finger action, and takes some skill to perfect for any caregiver," Teach says.

The study, published in June in the Annals of Allergy, Asthma and Immunology, found that almost a third of caregivers in low-income urban areas improperly used albuterol, a medicine given to help alleviate constricted airways in people with asthma. The researchers surveyed 114 caregivers by telephone and found that 32 percent gave too much or too little of the medicine.

Teach says that many caregivers and children old enough to take the medicines on their own often fail to use a spacer or holding chamber. These inexpensive plastic devices can help control the flow of the medicine and increase the chance that it will be delivered to the lungs rather than to the back of the throat, where it's largely useless.

Teach cites another common mistake affecting the many patients who have different asthma medications for daily and emergency use: They or their caregivers use one when it's the other that's needed.

Teach recommends that every child with asthma have an action plan that is reviewed with an asthma specialist at least once each year and after any asthma-related visit to an emergency room.

In January, the aerosol inhalers that had been used to deliver asthma medicines were replaced by environmentally friendlier ones, called HFA inhalers. Teach says that while the inhalers work slightly differently (the new devices produce a softer, gentler stream than the older ones), his colleagues have seen no problems getting the right dose to patients when a spacer is used.

Caregivers may also want to ask pediatricians for asthma inhalers that come with counters -- not all do -- to help make sure they don't run out of medication. (Without a counter, people often shake a canister or see if it floats to determine if it is empty.)

While most albuterol inhalers contain 200 puffs of medicine, ReliOn makes a 60-puff canister with a built-in counter that sells for $9 at Wal-Mart. If your doctor agrees and prescribes it, this might be a good spare for backpacks and glove compartments. (Some families like to keep one inhaler at home and one at school for emergencies.)

Teach also reminds caregivers to follow instructions about cleaning and priming inhalers so that they do not become clogged.

Need a spacer refresher course? Go to the Web site of the American Academy of Chest Physicians,, click on "Patient Education," under "Education," then "Patient Instructions for Inhaled Devices."

-- Francesca Linzer Kritz

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