PURPOSE OF THE STUDY.
To determine if watching a brief video at pediatric office visits would improve metered-dose inhaler (MDI) technique in children with asthma.
Children with persistent asthma (n = 91) from 2 pediatric practices in North Carolina completed the study. The children were 7 to 17 years old, used an MDI, and had missed or incorrectly performed at least 1 step on an inhaler technique assessment.
Participants were randomized immediately after a medical visit to the experiment or control group. The intervention group watched a brief 3-minute video in either English or Spanish. Separate videos were available for use of MDI with or without a spacer. Both inhaler videos provided an overview of the MDI device and specific instructions on proper use of the device. Children watched the videos on a laptop and were given a Web address and login information so that they could watch the video again after leaving the clinic. The control group watched a 3-minute video about nutrition in either English or Spanish. Children’s inhaler technique was assessed by a research assistant at baseline as part of the eligibility screen, immediately after the initial office visit and again at a 1-month follow-up. MDI technique was measured as number of steps completed correctly out of 8 possible steps.
Forty-six families were randomly allocated to the intervention group and 45 to the control group. Eighty-three families of 91 (91%) completed the 1-month follow-up visit. At baseline, children most frequently performed the following 2 steps incorrectly: forgetting to shake the MDI (69% for MID with a spacer and 57% for MDI without a spacer) and not holding their breath for 10 seconds (96% for MDI with spacer and 94% for MDI without spacer). In the intervention group, there was significant improvement in MDI technique postintervention (mean = 1.12, 95% confidence interval [CI] 0.73–1.5) and at 1-month follow-up (mean = 0.87, 95% CI 0.47–1.26). The control group did not show statistical significance in MDI technique postintervention (mean = 0.03, 95% CI –0.36 to 0.42) or at 1-month follow-up (mean = 0.32, 95% CI –0.09 to 0.73). The between group mean difference of 1.08 steps was statistically significant (95% CI 0.53–1.63) immediately postintervention but not at 1-month follow-up (mean = 0.55 steps, 95% CI –0.02 to 1.11).
In children with persistent asthma, using a 3-minute video after a regularly scheduled pediatric office visit resulted in immediate statistically significant 1-step mean improvement in MDI technique. This improvement, however, was not maintained at 1-month follow-up.
This was the first randomized controlled trial to assess whether a brief video intervention could be used to improve inhaler techniques in children. It is recommended by national guidelines that providers assess inhaler technique at each medical visit. Given time constraints of clinicians and asthma education metrics requirements from insurance payers, brief technique videos may offer a streamlined educational approach in the office setting. Spacer technique education offers a high-yield opportunity to improve asthma medication compliance.
- Copyright © 2015 by the American Academy of Pediatrics