Evaluation of Inhalation Chamber Usage Practices in Asthmatic Children

##plugins.themes.academic_pro.article.sidebar##

Published Jan 22, 2026
https://doi.org/10.62438/tunismed.v103i11.6029
Download
PDF
Vol. 103 No. 11 (2025): Tunis Med Nov 2025

##plugins.themes.academic_pro.article.main##

Khadija Belcadi
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco
Sara Aminou
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco
Kaoutar Dib
Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy of Rabat, Mohamed V University in Rabat, Morocco.
Fadoua Benbrahim
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco
Ghyzlaine Jaabouti
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco
Soumaya Benchakroun
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco
Naima El Hafidi
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco
Chafik Mahraoui
Pediatric Pulmonology-Allergology and Infectious Diseases Service, Rabat Children's Hospital, Mohammed V University - Souissi, Morocco

Abstract

Introduction-Aim :Asthma, the leading chronic illness among children, requires precise management to prevent exacerbations. This study examines the inhalation chamber usage practices among 402 asthmatic children at the Children’s Hospital of Rabat, identifying common errors and risk factors.


Methods : A prospective study was conducted with 402 children aged 2 to 16, all with a confirmed asthma diagnosis, using an inhalation chamber and having attended at least one therapeutic education session. Data were entered into Microsoft Office Excel 2019 and analyzed using JAMOVI Project. A p-value < 0.05 was considered statistically significant.


Results: Among the 402 children included, approximately 50% did not correctly master the inhalation technique. The most common errors were shallow breathing (38%), an insufficient number of respiratory cycles (19%), and failure to shake the inhaler before use (12%). Better technique mastery was significantly associated with age (better in adolescents), parental education level, the number of therapeutic education sessions received, and the time since the last medical consultation. Finally, asthma control was significantly better in children who demonstrated good inhalation technique mastery.


 Conclusion : Proper inhalation chamber technique is essential for effective asthma control. The frequent errors observed highlight the need to strengthen therapeutic education, particularly for younger children and families with limited educational backgrounds. Targeted interventions could enhance device usage and improve clinical

Keywords:

Pediatricasthma , Therapeuticeducation, Inhalation technique, Asthma control

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. The Global Asthma Report. Int J Tuberc Lung Dis. 2022;26:S1–S102. ISBN: 978-0-473-63703-3.
  2. Global Initiative for Asthma. Global strategy for asthma management and prevention. Bethesda: National Institutes of Health; 2024.
  3. Blais L, Suissa S, Boivin JF, Ernst P. First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma. Thorax. 1998;53(12):1025–9.
  4. Gillette C, Rockich-Winston N, Kuhn JA, Flesher S, Shepherd M. Inhaler technique in children with asthma: A systematic review. Acad Pediatr. 2016. doi:10.1016/j.acap.2016.04.006.
  5. Dalcin Pde T, Grutcki DM, Laporte PP, Lima PB, Menegotto SM, Pereira RP. Factors related to the incorrect use of inhalers by asthma patients. J Bras Pneumol. 2014;40(1):13-20. doi:10.1590/S1806-37132014000100003. PMID: 24626265; PMCID: PMC4075912.
  6. Al-Jahdali H, Ahmed A, Al-Harbi A, Khan M, Baharoon S, Bin Salih S, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy Asthma Clin Immunol. 2013;9(1):8. doi:10.1186/1710-1492-9-8. PMID: 23510684; PMCID: PMC3605255.
  7. Sleath B, Ayala GX, Gillette C, et al. Provider demonstration and assessment of child device technique during pediatric asthma visits. Pediatrics. 2011;127(4):642-8.
  8. Carpenter DM, Ayala GX, et al. Communication during pediatric asthma visits and child asthma medication device technique 1 month later. J Asthma. 2012;49(9):918-25.
  9. Scarfone RJ, Capraro GA, Zorc JJ, Zhao H. Demonstrated use of metered-dose inhalers and peak flow meters by children and adolescents with acute asthma exacerbations. Arch Pediatr Adolesc Med. 2002;156(4):378-83.
  10. Hagmolen of Ten Have W, Van De Berg NJ, Bindels PJE, Van Aaldered WMC, Van Der Palen J. Assessment of inhalation technique in children in general practice: Increased risk of incorrect performance with new device. J Asthma. 2008;45:67-71.
  11. Capanoglu M, Misirlioglu ED, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children using metered dose or dry powder inhalers. J Asthma. 2015;52(8):838-45.
  12. van Beerendonk I, Mesters I, Mudde AN, Tan TD. Assessment of the inhalation technique in outpatients with asthma or chronic obstructive pulmonary disease using a metered-dose inhaler or dry powder device. J Asthma. 1998;35:273-9.
  13. van Beerendonk I, Mesters I, Mudde AN, Tan TD. Assessment of the inhalation technique in outpatients with asthma or chronic obstructive pulmonary disease using a metered-dose inhaler or dry powder device. J Asthma. 1998;35:273-9.
  14. Warner JO, Naspitz CK, Cropp GJA. Third international pediatric consensus statement on the management of childhood asthma. Pediatr Pulmonol. 1998;25:1-17.
  15. Kamps AWA, Brand PLP, Roorda RJ. Determinants of correct inhalation technique in children attending a hospital-based asthma clinic. Acta Paediatr. 2002;91:159–63.
  16. Hesselink AE, Penninx BW, Wijnhoven HA, Kriegsman DM, van Eijk JT. Determinants of an incorrect inhalation technique in patients with asthma or COPD. Scand J Prim Health Care. 2001;19(4):255-60. doi:10.1080/02813430152706792. PMID: 11822651.
  17. Kraemer R, Birrer P, Modelska K, Casaulta Aebischer C, Schöni MH. A new baby-spacer device for aerosolized bronchodilator administration in infants with bronchopulmonary disease. Eur J Pediatr. 1992;151:57-60.
  18. Dessanges JF, Rivoal V. Les chambres d’inhalation. Rev Fr Allergol. 1998;38:103-8.
  19. Bisgaard H, Anhoj J, Klug B, Berg E. A non-electrostatic spacer for aerosol delivery. Arch Dis Child. 1995;73:226-30.
  20. de Blic J. Particularités d’utilisation des chambres d’inhalation chez le nourrisson. Rev Fr Allergol. 1998;38:99-102.
  21. Gillies J. Overview of delivery system issues in pediatric asthma. Pediatr Pulmonol. 1997;15 Suppl:55-8.
  22. Berg E. In vitro properties of pressurized metered dose inhalers with and without spacer devices. J Aerosol Med. 1995;8 Suppl:3-10.
  23. Janssens HM, Devadason SG, Hop WCJ, Le Souëf PN, De Jongste JC, Tiddens HAWM. Variability of aerosol delivery via spacer devices in young asthmatic children in daily life. Eur Respir J. 1999;13:787-91.
  24. Price DB, Thomas V, Dekhuijzen PN, et al. Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: The Easy Low Instruction Over Time (ELIOT) study. BMC Pulm Med. 2018;18:107.
  25. Gregoriano C, Dieterle T, Breitenstein AL, et al. Use and inhalation technique of inhaled medication in patients with asthma and COPD: Data from a randomized controlled trial. Respir Res. 2018;19:237. doi:10.1186/s12931-018-0936-3.
  26. Maricoto T, Correia-de-Sousa J, Taborda-Barata J. Inhaler technique education in elderly patients with asthma or COPD: Impact on disease exacerbations—a protocol for a single-blinded randomized controlled trial. BMJ Open. 2019;9:e022685. doi:10.1136/bmjopen-2018-022685.
  27. Foland AP, Stern T, Ramacciotti T, et al. Improvement of metered-dose inhaler administration technique: The effect of training sessions at a specialized pediatric asthma compliance and technique clinic. Curr Ther Res Clin Exp. 2002;63:142-47.
  28. Chan DS, Callahan CW, Hatch-Pigott VB, et al. Internet-based home monitoring and education of children with asthma is comparable to ideal office-based care: Results of a 1-year asthma in-home monitoring trial. Pediatrics. 2007;119(3):569-78.
  29. Kamps AWA, van Ewijk B, Roorda RJ, Brand PLP. Poor inhalation technique, even after inhalation instructions, in children with asthma. Pediatr Pulmonol. 2000;29:39-42.
  30. Veylon P, Rochoy M, Gautier S, et al. Évaluation théorique et pratique de la connaissance d’utilisation des dispositifs inhalés dans l’asthme chez les internes en médecine générale et les étudiants en pharmacie de Lille. Rev Pneumol Clin. 2018;74(2):67-75.
  31. Rodriguez-Garcia C, Barreiro E, Muñoz-Gall X, et al. Common errors in inhalation therapy: Impact and solutions. Clin Respir J. 2020;14(11):1001-1010.
  32. Liu W, Jiesisibieke ZL, Tung T. Effect of asthma education on health outcomes in children: a systematic review. Arch Dis Child. 2022;107:1100-1105.
  33. Alatawi A. The effectiveness of asthma education approaches for children: group versus individual education. Biomed J Sci Tech Res. 2017.
  34. Drummond D. Outils connectés pour la télésurveillance des patients asthmatiques : gadgets ou révolution? Rev Mal Respir. 2022;39(3):241-257.
  35. Benjaponpitak S, Direkwattanachai C, Kraisarin C, Sasisakunporn C. Incorrect use of metered dose inhaler by pediatric residents. J Med Assoc Thai. 1996;79:122-125.
  36. Self TH, Brooks JB, Lieberman P, Ryan MR. The value of demonstration and role of the pharmacist in teaching the correct use of pressurized bronchodilators. Can Med Assoc J. 1983;128:129-131.