Are children with asthma overconfident that they are using their inhalers correctly?

Abstract

Objective: The objectives of this study were to quantify the extent to which children with asthma are overconfident that they are using their inhalers correctly and determine whether demographic and clinical characteristics are associated with children being overconfident. Methods: Children (n = 91) ages 7–17 with persistent asthma were recruited at two pediatric practices in North Carolina and demonstrated their inhaler technique for metered dose inhalers during an office visit. Children were dichotomized into two groups based on how confident they were that they were using their inhalers correctly: “completely confident” or “not completely confident”. The mean number of inhaler steps (out of 8) children performed incorrectly was examined. We applied linear regression models for children in the “completely confident” group to determine whether demographic and clinical factors predicted their overconfidence, defined as the number of inhaler steps performed incorrectly. Results: Children were primarily male (56%) and non-Hispanic White (60%). Sixty-eight (75%) children were “completely confident” that they were using their inhalers correctly. The “completely confident” group missed an average of 1.5 steps. In the “completely confident” group, males (p < 0.04) missed significantly more steps than females. The two most common errors were forgetting to shake the inhaler and holding their breath for 10 s. Conclusion: Regardless of their confidence level, children in our sample missed an average of 1–2 steps on an inhaler technique assessment. Findings from this study provide new evidence that it is insufficient to ask children if they are using their inhalers correctly. Therefore, it is vital that providers ask children to demonstrate their inhaler technique during health encounters.

• Asthma
• asthma control
• children
• inhaler technique
• self-efficacy

Acknowledgements

We thank Tamera Coyne-Beasley, Dan Reuland, and the ENLaCE network for assistance with recruiting study participants.

Declaration of interest

The authors report that they have no conflicts of interest. The authors alone are responsible for the content and writing of this article. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. This project was supported by Award Number ULTR000083 from the National Center for Advancing Translational Sciences. Dr. Carpenter’s salary was partially supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR001109 and UL1TR001111. The results from this study have been presented as a poster presentation in March 2014 at the American Pharmacists Association Annual Conference in Orlando, Florida.