Poor inhaler technique is one of the most common and most underrecognised reasons for inadequate asthma control in children, even when the right medication has been prescribed.
A child using a metered-dose inhaler without a spacer delivers only a fraction of the dose to the lungs, with most of it depositing in the mouth and throat. A child using a dry powder inhaler without generating sufficient inspiratory flow achieves the same poor result. In both cases, the medication is being taken but not reaching the airways where it is needed. At every consultation I review inhaler technique directly with the child and the parent rather than assuming it is correct. A child whose asthma appears to be poorly controlled despite adequate medication doses, before any decision to step up treatment is made, should have inhaler technique formally reviewed. In my experience, correcting technique alone frequently resolves what appeared to be treatment-resistant asthma.
Written by Dr Divyank Pathak, MBBS, MD (Pediatrics), IFPCCM, DPAA, FNPP, DPSM, FAAP, Director and Senior Consultant Paediatrician, Pediatric Critical Care and Allergy and Asthma Specialist, Vatsalya Superspeciality Children Hospital, Mahavir Road, Varanasi, Uttar Pradesh 221002.
