‘STOP for Asthma’ is this year’s World Asthma Day theme, where STOP expands into Symptom evaluation, Test response, Observe and assess, Proceed to adjust treatment. With the World Health Organization’s rough estimates pointing out that about 10% to 15% of children (five to 11 years old) in India suffer from asthma, we look at an area that needs more ‘observing and assessment’, the misuse of the inhaler.
“When parents see that the condition of their child is not improving, they come back asking for a higher dose. But most of the time the problem is with how you use the inhaler. For very young children, we have special devices called spacers which can be attached to the inhaler. These vary with age and special instructions are given to parents about how and when to use it. The key is not to give up even if the kid is fidgety. These small things make a huge difference,” says Dr Ayesha Shahnaz, Consultant Paediatric Pulmonologist at Apollo Children’s Hospital, Chennai.
A recent study published in the Journal of Hospital Medicine , conducted in the US, highlighted the fact that approximately 42% of the children studied did not use the inhaler properly, and were thus not getting the required dose of medicine.
“An improper inhaler technique can contribute to children having uncontrolled asthma and needing to come to the hospital for their asthma,” said lead author Waheeda Samady, in a release.
Confidence vs competence
“My son started using the inhaler when he was four; I think he is using it right. When he first started using, we went back to the doctor with the inhaler and he showed us the proper technique,” says Gayathri R, mother of an 11-year-old from Chennai.
But another study says that this confidence doesn’t match actual skill. The study, published in Annals of Allergy, Asthma & Immunology, showed that though parents and kids said they knew how to use it, more than 90% exhibited misuse. The authors say that most parents lack the required knowledge on proper inhaler techniques. The lack of supervision may also play a role.
Dr Shahnaz adds that these studies hold important lessons for India, which has a high number of childhood asthma cases.
Talk to your doctor to learn the proper techniques. Children may find it difficult to coordinate breathing with inhaling the medicine. They need the spacer along with the inhaler to administer the drug properly into the smaller, deeper airways. Help them to use it right. “Most kids are just curious about what it is. Using an inhaler causes no pain or irritation. Once the child is relieved, they’re okay with using it,” says Dr Jaya Kumar Reddy, Paediatrician at Apollo Children’s Hospital, Chennai.
- If the canister and spacer are used regularly, it can be washed once a week with plain water and dried thoroughly. Do not sterilise or use cleaning lotion, brushes. Ask your doctor about rinsing the throat after inhalation, as it is not mandatory and depends on the drug used.
He adds that some parents are sceptical about inhalers. “For an eye infection, would you use one drop in the eye or rather drink litres of the same drug? Similarly, an inhaler delivers micrograms of drugs into your airways, which would require 20 times if taken orally.”
He also asks parents to maintain a book to identify the trigger or allergens. It may be a cloth store, park or a particular relative’s house. Identify that and try to avoid it. “Some parents think it is okay to smoke at the office and come back home. No. Your clothes or shoes may still hold the allergens and irritate your kid.”
Avoid discontinuing a medicine when your child is better, as this can have long-terms effects. Do consult with your doctor on how to taper medicines that are not SOS.
