2001 OPEN FORUM Abstracts
COMPARISON OFPRESSURIZED METER DOSE INHALER (pMDI) TECHNIQUE IN TWO PEDIATRIC SPECIALTY CLINICS.
James E. Martin, RRT, SusanR. Ogrinc, RRT, Robert C. Cohn, MD, Departments of Pediatrics, and PulmonaryServices, MetroHealth Medical Center, Cleveland, OH
INTRODUCTION: Asthma is themost common chronic disease of childhood affecting an estimated 4.8 millionchildren. Routinely, inhaled medications are prescribed for prevention and rescuetherapy. Many forms of delivery systems are available for the inhalation route.Proper use and compliance with taking all medications is important to ensureadequate control of symptoms. A Pediatric Asthma Compliance and Technique (PACT)Clinic was established with one of its primary goals to form a simple but effectiveasthma plan consisting of medications given by the pMDI.
Methods: Thirty six pediatricasthma patients on inhaled medication were evaluated for proper use of pMDItechnique according to the 1997 NHLBI Guidelines for the Diagnosis and Managementof Asthma. The case control study consisted of 18 patients from an establishedPediatric Pulmonary Clinic (PPC) and 18 patients from the PACT clinic. The groupswere similar in age, PPC mean 10.89 (range 6-17), PACT 9.94 (6-17) and prebronchodilatorFEV1, PPC mean 88.5% (52-125%), PACT 85.2% (59-103%). Each patientneeded to be seen a minimum of two times for analysis. The only difference beingthat in the PACT clinic all patients were evaluated for technique on their initialvisit. After allowing the patient to demonstrate the technique without prompting,a thorough review and demonstration was performed by the respiratory therapist.Each unsuccessful step was highlighted on a patient education hand out and givento the patient.
Results: On average both groupsperformed a median of 4/8 (50%) of the steps correctly on the initial evaluation.No one was able to perform all steps satisfactory. On the second visit, thePACT patients performed a median of 7/8 (88%) (range 4-8) steps correct, with5/8 steps performed significantly better than their PPC counterparts (p<.02, sign test). With success being 8 correct steps, the PACT group had6/18 (33%) patients who could performed all 8 steps correct as compared to thePPC patients (p .031).
CONCLUSION: After one intenseeducation session, the PACT patient demonstrated a greater success rate as comparedto their counterparts. Even in an established Pediatric Pulmonary Clinic onecan not assume that proper pMDI technique was taught to the patient and thereforeroutine competency testing on the proper use of the inhaled medication is importantto ensure adequate medication delivery.