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Spring-Summer, 2012

Asthma Research into Action

Show and Tell: Teaching Children with Asthma How To Use Asthma Devices

Betsy Sleath, Ph.D., a sociologist with a background in pharmacy, first became interested in asthma when her daughter was six years old and would have friends sleep over at their home.

Dr. Betsy Sleath of the UNC Eshelman School of Pharmacy Dr. Betsy Sleath and her daughter

“Before they came over we had to think carefully about how to prepare, because we have cats and dogs and pet dander is a potential trigger for an asthma attack,” said Dr. Sleath of the UNC Eshelman School of Pharmacy. “The girls’ mothers were knowledgeable about their children’s asthma, but it led me to realize that we need to teach children how to manage their disease at a young age in case mom or dad is not around.”

Having witnessed her own mother manage diabetes daily, Dr. Sleath was steeped in chronic disease management from an early age herself. This is what triggered her interest in examining what role communication plays in the management of chronic diseases and what ultimately led her and a group of colleagues to explore whether children with asthma were using various asthma devices properly.

What they found is disheartening.

"Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits”—of which Dr. Sleath was the lead author—aimed to do the following:

  • Describe the extent to which children use metered-dose inhalers, turbuhalers, diskuses, and peak flow meters correctly
  • Investigate how often providers assess and demonstrate use of these same devices during pediatric asthma visits

Researchers examined a diverse group of 8- to 16-year-old English-speaking children with a range of asthma severity at five pediatric practices across nonurban North Carolina. Thirty percent of the pediatric asthma patients were African American, and 10 percent were Native American. Following medical visits, research assistants interviewed children and asked them to demonstrate how they used their devices. All of the visits were audio-taped. Of these tapes, 296 were useable and analyzed.

The study found that the vast majority of children did not perform all of the key steps for each device. The following is a breakdown by device of what percentage of children correctly performed all of the steps:

  • Diskus: 22%
  • Metered-dose inhaler: 8%
  • Peak flow meter: 24%
  • Turbuhaler: 16% 

Researchers also discovered that a majority of providers weren’t demonstrating how to use the devices or asking patients to demonstrate how they (patients) were using them.

“We found that very simple steps were being missed by patients, such as blowing air out before they inhaled from the device, holding their breath long enough, and even shaking an inhaler before use,” said Sleath.

Sleath does not fault the participating clinics, as they are overwhelmed with patients. However, she does encourage clinicians to be aware of these challenges and families to not only bring the devices to their child’s appointment but also to ask for help and guidance at the pharmacy as the the proper use of these devices.

“There are more and more asthma devices on the market, and every device is different,” said Dr. Sleath. “That’s why I believe that pharmacists could play a key role in showing someone how to use the device properly before they leave the pharmacy with the medication. It’s what pharmacists are trained to do!”

Sleath believes awareness and action by all parties is the lasting solution to this challenge, and in parting words, encourages the mothers, fathers, and caregivers of children with asthma to

“Take charge!”

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Last Updated June 2012