Study: Confidence in kids' asthma inhaler technique doesn’t match actual skills

Many children with asthma think they are using their asthma inhaler medications correctly when they are not. This makes it very difficult to keep their asthma under control. A new study in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI) finds African American school children, along with their parents, had misplaced confidence in their asthma inhaler technique.

“We know from past studies that both parents and children overestimate the ability of children to properly use their inhaler,” said Anna Volerman, MD, lead study author and an assistant professor at the University of Chicago Medicine. “We examined whether parent and child confidence were the same and whether either was a good sign of the child’s actual ability to use the inhaler correctly. We found most parents and children overestimated the children’s ability based on high confidence by the child — despite inhaler misuse.”

The study surveyed 65 pairs of parents and children at four Chicago public charter schools. The age range of the children was 8 to 14 years, most were male and 90 percent were African American. Most parents (80 percent) were female. Nearly all children (97 percent) misused their inhaler. One child demonstrated mastery. A small proportion of children and parents accurately matched their confidence to their child’s technique. Five percent of children who were confident in their inhaler technique used their inhaler without misuse, while 4 percent of children whose parents were confident properly used their inhaler. None of the parents underestimated the children’s skills.

“It’s not enough for an allergist or other health care provider to ask a child or their parents if the child knows how to use an inhaler,” says allergist Todd Mahr, ACAAI president. “Simply asking is not a reliable screening tool to determine who needs additional education on how to properly use an inhaler. If your child has asthma, check with your allergist to make sure your child has proper inhaler technique. Bring the inhaler with you to your next appointment and have your allergist or one of their staff watch your child use it.”

The study results showed parents may be less accurate in predicting their child’s inhaler ability than their child. The authors thought potential reasons may be children’s daily experience with inhalers, parents’ lack of knowledge about proper inhaler technique or parents’ limited supervision of care.