Evaluating Inhaler Education Intervention for Hospitalized Children With Asthma: A Randomized Controlled Trial

To evaluate whether the virtual teach-to-goal (V-TTG) method is correlated with less inhaler misuse among children with asthma who are hospitalized when compared with brief intervention (reading the steps aloud).The study population included children aged 5 to 10 years with asthma and their caregivers who were recruited via the electronic health record when the child was hospitalized for wheezing or asthma. Eligible participants were admitted to the general pediatrics service. Inclusion criteria were the use of a short-acting bronchodilator every 2 hours or less, use of a metered-dose inhaler with spacer or valve-holding chamber and no mask, and use of the inhaler independently.The study was a randomized controlled trial conducted between January 2019 and February 2020 at a single urban hospital. Baseline demographic and clinical assessments were obtained via several questionnaires. The Childhood Asthma Control Test, Pediatric Asthma Impact Scale, and Pediatric Asthma Caregiver’s Quality of Life Questionnaire were administered. Study staff assessed inhaler technique using a validated 12-step checklist. The V-TTG group used a tablet to complete the educational module based on their age and sex. Children then viewed a video demonstration of proper inhaler technique, followed by completion of assessment questions to determine postintervention knowledge. If any questions were answered incorrectly, the participant watched tailored educational videos followed by reassessment. Participants repeated the cycle of education and assessment for up to 3 rounds until they showed perfect knowledge. In the brief intervention group, the research assistant provided verbal inhaler technique instruction, without demonstration, by reading each step aloud. Next, each participant was given a printed copy of the steps, followed by participant demonstration of inhaler technique. Two research assistants assessed technique based on the 12-step checklist – the first research assistant completed checklist in real-time, whereas the second research assistant completed the checklist based on a video recording. The primary outcome was the proportion of participants with inhaler misuse, defined as achieving fewer than 10 correct steps after intervention.Of the 251 children screened, 140 participants met inclusion criteria. Analysis included 70 participants, of which 34 were randomized to the V-TTG group, whereas 36 were randomized to the brief intervention group. The mean age of the children was 7.8 years. The majority of participants (86%) were Black, and about half of participants (48.6%) were female. At baseline, nearly all children (96%) in both groups misused inhalers without significant difference between the groups (P = .2). The proportion of inhaler misuse significantly decreased after intervention in both groups (V-TTG:100% to 74%, P = .002 and brief intervention: 92% to 69%, P = .04). However, there was no significant difference in misuse between the 2 groups. When comparing pre and postintervention technique, older children (ages 8–10 years) were significantly more likely to demonstrate more correct steps when compared with younger children (ages 5–7 years) (mean change = 1.9 vs 1.1, P = .002).In children aged 5 to 10 years with asthma who were hospitalized for wheezing or asthma, both the V-TTG and brief intervention groups showed statistically significant improvement in inhaler technique after educational intervention. Older children had greater improvement in technique following intervention compared with younger children.As the incidence of asthma exacerbations continues to increase and impact the healthcare system, multiple studies have been conducted to evaluate methods for reducing hospitalizations and emergency department visits. This randomized control trial focused on V-TTG and brief intervention as methods to improve inhaler technique. The study provides evidence that the use of V-TTG and brief intervention improves inhaler technique; however, areas of further research include long-term retention of inhaler technique and the number of hospitalizations and emergency department visits following an intervention. Although further research to investigate methods for providing patient education via high-fidelity, low-resource intervention warrants exploration, it is important that healthcare providers are aware of the positive impact that V-TTG and brief intervention have on inhaler technique, especially in older children.