Abstract
Background: Incorrect use of inhaler devices has a major influence on asthma control. Assessment of the inhalation technique of asthma patients is important. For this purpose the Dutch Asthma Foundation has developed a 7-points checklist. This checklist has not been validated in young children.
Objective: To assess reliability and validity of the checklist in preschool children with asthma using a metered dose inhaler with spacer.
Methods: 20 children (6m-6y). All patients were treated with daily inhaled corticosteroids (ICS). The inhalation technique was recorderd on videotape and indepently assessed by 6 observers using the Dutch Asthma Foundation checklist (0-7 points) and a general impression of the inhaler technique (0-10). This assessment was repeated after 2 weeks.
Results: Inter-observer-agreement (IOA) was fairly good for the checklist (Intraclass Correlation Coefficient=ICC: 0.70, range 0.42-0.87) and the general impression (ICC: 0.64, range 0.50-0.90). IOA however was moderate with ICC 0.48 for the checklist and ICC 0.50 for the general impression.
IOA of items 1-5 was good (>75% (Kappa> 0.7)). IOA of items 6-7 was less (<60% (Kappa < 0.45)).
Comparison of the general impression (0-10) and the checklist showed poor agreement. (mean diff. of 2 points and limits of agreement -1.5 to 5.52). This means that the checklist gave higher scores than the general impression.
Conclusion: Reliability and validity of assessment of inhalation technique in young children is suboptimal. IOA in assessment of inhalation technique in young children using metered dose inhaler with spacer is moderate. No difference was observed when a general impression was given or a checklist was used.
- © 2011 ERS