van der Kolk Annelies, Lammers Natasja, Brusse-Keizer Marjolein, van der Palen Job, Faber Joyce, Spenkelink-Visser Reina, Thio Bernard J
Dept of Pediatrics, Deventer Ziekenhuis, Deventer, The Netherlands.
Dept of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands.
ERJ Open Res. 2021 Apr 19;7(2). doi: 10.1183/23120541.00215-2019. eCollection 2021 Apr.
Asthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to 1) compare daily inhalation technique with the Diskus and Autohaler in asthmatic children by filming inhalations at home and 2) compare daily inhalation technique with technique demonstrated in the hospital.
We performed a randomised study in asthmatic children (aged 6-18 years) from the outpatient clinic of Medisch Spectrum Twente hospital (Enschede, The Netherlands) from July 2014 to April 2016. Children received inhalation instructions for the Diskus and Autohaler and were randomised to use one device in the morning and the other in the evening. During the 28-day study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for seven critical errors per device.
636 videos with the Diskus and 663 with the Autohaler were provided by 27 children. The most common critical error in daily life was an incorrect device position during preparation of the Diskus (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler. Percentage of correct days using the Diskus was 44%, compared to 96% with the Autohaler (p<0.001). The two most common errors with the Diskus were made at least twice as often at home than in the hospital.
Inhalation technique at home was markedly better with the Autohaler than with the Diskus. Paediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus.
哮喘是儿童期最常见的慢性疾病，抗炎药物是治疗的基石。在医院演示时，吸入器的使用经常不正确，这表明在家中的使用技巧欠佳。我们旨在：1）通过在家中拍摄哮喘儿童使用都保（Diskus）和自动吸入器（Autohaler）的吸入过程，比较这两种吸入器的日常吸入技巧；2）将日常吸入技巧与在医院演示的技巧进行比较。
2014年7月至2016年4月，我们在荷兰恩斯赫德的特温特医学光谱医院门诊对哮喘儿童（6 - 18岁）进行了一项随机研究。儿童接受了都保和自动吸入器的吸入指导，并被随机分配在早上使用一种装置，晚上使用另一种装置。在为期28天的研究期间，在家中拍摄吸入过程，随后在医院进行演示。检查每个装置的所有吸入过程是否存在七个关键错误。
27名儿童提供了636段使用都保的视频和663段使用自动吸入器的视频。日常生活中最常见的关键错误是使用都保时准备过程中装置位置不正确（n = 271），以及使用自动吸入器时吸气不够深（n = 39）。使用都保的正确天数百分比为44%，而使用自动吸入器的为96%（p < 0.001）。都保最常见的两个错误在家中出现的频率至少是在医院的两倍。
自动吸入器的家庭吸入技巧明显优于都保。儿科医生应意识到，基于医院的演示可能高估了都保的日常吸入技巧。
