Assessment of pMDI inhaler technique in children and adolescents with cystic fibrosis

OBJECTIVE: To assess the quality of pressurized metered-dose inhaler (pMDI) technique among patients with cystic fibrosis (CF) and their caregivers, and identify associated clinical and socioeconomic factors. METHODS: Cross-sectional study of 146 CF patients (≤ 18 years) followed at a reference center in 2025. Inhaler technique was assessed using a study-specific 11-step checklist with age-based adaptations. Adequate technique required correct performance of ≥ 70% of eligible steps, including all essential steps. Socioeconomic and clinical data were obtained from medical records and structured interviews. RESULTS: The overall adequacy rate was 68.4%. The 0-5-year age group showed higher adequacy than those ≥ 6 years (85.1% vs. 60.6%). Main errors were re-shaking for the second puff in children < 6 lt; 6 years (31.9%) and slow exhalation in those ≥ 6 years (81.8%). Multivariate logistic regression identified early childhood (0-5 years, OR = 5.16; 95% CI: 1.78-14.91; p = 0.002) and family income of 2-3 minimum wages (OR = 0.30; 95% CI: 0.10-0.90; p = 0.032) as independent predictors of technique quality. CONCLUSIONS: Nearly one-third of children and adolescents with CF had inadequate pMDI technique (31.6%). Respiratory coordination and re-shaking for the second puff were the main errors identified. Early childhood (0-5 years) was independently associated with better technique, whereas family income of 2-3 minimum wages predicted poorer performance. The developed checklist proved viable for multidisciplinary CF consultations. Longitudinal, multicenter studies using validated instruments are needed to establish causality and assess the impact of systematic educational interventions.