De Boeck K, Alifier M, Warnier G
Pediatric Pulmonology, the Department of Pediatrics, University Hospital of Leuven, Belgium.
J Allergy Clin Immunol. 1999 May;103(5 Pt 1):763-7. doi: 10.1016/s0091-6749(99)70417-3.
The metered-dose inhalers are the most commonly used devices in the treatment of asthma, but dry powder inhalers (eg, Turbohaler) are being increasingly used. Studies evaluating how well children can use a Turbohaler are lacking.
We assessed whether the correct use of a Turbohaler could be easily taught to unselected stable asthmatic children.
One hundred sixty-one asthmatic children aged 5 to 17 years (mean, 9.8 years) consecutively attending the outpatient clinic were included in study. After a demonstration and 10 minutes of training, the inhalation technique was checked in a standardized way (yes/no response). Keeping the device upright, proper preparation of the drug dose and inspiratory flow on inhalation were measured by the Turbohaler trainer.
One hundred thirty-three children (83%) performed every step correctly (ie, 96% of children older than 8 years but only 55% of children between 5 and 8 years; P <.001). Of 28 children incorrectly using the Turbuhaler-trainer, 20 generated insufficient inspiratory flow through the device. There was no significant difference in airway obstruction (expressed as percent of predicted forced vital capacity, FEV1, and Tiffeneau index) between correct and incorrect users, but when measured through the pneumotachograph, mean peak inspiratory flow (expressed as percent predicted) was significantly lower in those children incorrectly using the device. Turbohaler use was reevaluated after 4.7 +/- 2.0 months in a subset of 64 patients. Fifty-three of 64 (83%) children again used the device correctly. Only 3 of 13 who used the device incorrectly at the first evaluation used it correctly at the second evaluation.
We conclude that the correct use of the Turbohaler can be easily taught to asthmatic children older than 8 years. Those who use the device correctly after initial instructions continue to do so afterwards.
定量吸入器是治疗哮喘最常用的装置，但干粉吸入器（如都保）的使用越来越广泛。目前缺乏评估儿童使用都保情况的研究。
我们评估了未经过挑选的病情稳定的哮喘儿童是否能轻易学会正确使用都保。
连续纳入161名年龄在5至17岁（平均9.8岁）的哮喘儿童门诊患者。经过示范和10分钟的培训后，以标准化方式检查吸入技术（是/否回答）。使用都保训练器测量保持装置直立、正确准备药物剂量以及吸入时的吸气流量。
133名儿童（83%）各项步骤操作正确（即8岁以上儿童中有96%正确，但5至8岁儿童中只有55%正确；P<0.001）。在28名使用都保训练器不正确的儿童中，有20名通过装置产生的吸气流量不足。正确使用者和不正确使用者之间的气道阻塞情况（以预计用力肺活量、第一秒用力呼气容积和蒂芬诺指数的百分比表示）无显著差异，但通过呼吸流速仪测量时，不正确使用该装置的儿童平均吸气峰流速（以预计值的百分比表示）显著较低。在64名患者的亚组中，4.7±2.0个月后重新评估都保的使用情况。64名儿童中有53名（83%）再次正确使用了该装置。在首次评估时使用不正确的13名儿童中，只有3名在第二次评估时使用正确。
我们得出结论，8岁以上的哮喘儿童能轻易学会正确使用都保。初次指导后正确使用该装置的儿童之后仍能继续正确使用。
