Comparison of inhalation technique with the Diskus® and Autohaler® in asthmatic children at home

Objective Asthma is the most common chronic disease in childhood and anti-inflammatory medication is the cornerstone of treatment. Inhalers are frequently used incorrectly when demonstrated in the hospital, suggesting poor technique at home. We aimed to: 1) Compare daily inhalation technique with the Diskus® and Autohaler® in asthmatic children by filming inhalations at home; 2) Compare daily inhalation technique with technique demonstrated in the hospital.

Methods We performed a randomised study in asthmatic children (6–18 years) from the outpatient clinic of MST hospital from July 2014 to April 2016. Children received inhalation instructions for the Diskus® and Autohaler® and were randomised to use one device in the morning and the other in the evening. During the 28-days study period, inhalations were filmed at home and subsequently demonstrated in the hospital. All inhalations were checked for 7 critical errors per device.

Results A total of 636 videos with the Diskus® and 663 with the Autohaler® were provided by 27 children. The most common critical error in daily-life was an incorrect device position during preparation of the Diskus® (n=271) and an insufficiently deep inhalation (n=39) using the Autohaler®. Percentage of correct days using the Diskus® was 44%, compared to 96% with the Autohaler® (p<0.001). The two most common errors with the Diskus® were made at least twice as often at home than in the hospital.

Conclusion Inhalation technique at home was markedly better with the Autohaler® than with the Diskus®. Pediatricians should be aware that hospital-based demonstrations can overestimate daily inhalation technique with the Diskus®.