Pharmacists Can Teach Asthma Inhaler Technique to Children While Motivating Treatment Adherence
No child should ever have to struggle to take in air or suffer when every breath is painful. Yet prevalence is on the rise. As if that isn’t bad enough, children with asthma face a higher risk of comorbidities that interfere with socialization, cause trouble at school, and lead to chronic health conditions.
Now stop to consider how difficult it is for children to use asthma inhalers properly, which means they may not get the right amount of medication—that’s if they even use it since adherence rates are low. It’s not an encouraging state of affairs but it can get better for children and their parents when pharmacists intervene to teach about medications and inhaler technique.
Rising Rates of Asthma and Comorbidities in Children
Research presented at the Pediatric Academic Societies (PAS) annual meeting in 2016 showed that the prevalence of asthma rose significantly between 2003 and 2011/12, with the largest increases occurring in children living in poverty:1
- Increase in prevalence of asthma:
- 19.8 percent increase in children aged 6 to 11 years
- 26.59 percent increase in children aged 12 to 17 years
- Overall prevalence is 1 in 11 children
- Poverty statistics:
- 29 percent of the children with asthma lived between 100 to 399 percent of the poverty level
- 13 percent were at or above 400 percent of the poverty level
Rising prevalence portends even larger health concerns because children with asthma face a higher risk of comorbidities. When researchers looked at 41 health conditions in nearly 11,000 children, they found that children with asthma had a higher incidence of nearly every condition compared to other children without asthma.2
Children with asthma had:
- 5 percent higher prevalence of hay fever or respiratory allergies
- 14 percent higher prevalence of eczema or skin allergies
- 11 percent higher prevalence of sinusitis
- 10 percent higher prevalence of food allergies
- Nearly 8 percent higher prevalence of difficulty with emotions, concentration, and behavior
Gaps in Patient Education and Low Levels of Adherence
Guidelines established by the National Asthma Education and Prevention Program (NAEPP) recommend that physicians develop an asthma action plan for each child and review medications, inhaler technique, and adherence at each follow-up visit.3 Yet according to CDC statistics, there’s a gap in their care:4
- About 8 in 10 children are taught how to recognize asthma symptoms.
- Less than half of children have an asthma action plan.
Adherence is another serious challenge. Overall, the adherence rate for patients with asthma is estimated to be 55 percent. In clinical trials that have used electronic monitoring devices for children, adherence ranged from 50 to 77 percent, which is probably better than the general population since these numbers came from study participants who may have been more diligent.5
Like many other health conditions, adherence improves when pharmacists get involved. The NAEPP evaluated controlled trials of pharmacist-delivered education and concluded that their efforts reduced symptoms, improved asthma control, and lowered hospitalizations.
Factors to Consider When Counseling Children with Asthma
One of the most important jobs for pharmacists is to teach children and their parents how to use an inhaler. One study reported that fewer than 24 percent of children can correctly perform all of the steps. If you haven’t had the opportunity to work with children, you’ll find step-by-step advice and a video demonstrating proper technique at the About Kids Health website.6
Educating about inhaler technique is also a great way to connect with kids. The time you spend with them establishes a connection, gives them a chance to ask questions and helps them feel confident—all of which motivate adherence to therapy.
When you work with children, you’ll need to be aware of factors that influence their adherence:
- Reminders are important – One of the primary reasons given for nonadherence is that the parents and/or children forget. Suggest parents use text messages or email to remind teens—younger children will respond to a calendar where they can place a sticker every day they adhere, then after a few weeks, they can trade in stickers for a small reward such as extra screen time.
- Parents with medical or psychological disorders – Children are at a higher risk for more frequent asthma attacks and reduced adherence when parents have health conditions.
- Children with asthma often have behavior problems – If there’s friction at home, they’ll be more motivated to learn about inhaler technique and medications from you rather than their parents.
- Parents don’t fill prescriptions – They may not believe the medication is necessary or face financial shortages, to name just two possible reasons. Offer to help them find manufacturers discount coupons and special offers.
- Unexpected triggers – They’re usually aware of typical asthma triggers, which means they’ll be more prepared to use an inhaler, but many parents and children don’t know about unexpected triggers like sunscreen.
How to Reach Out and Engage Children and Their Parents
The biggest obstacle to helping children with asthma is that children don’t come to the pharmacy with their parents. A study published in the January 2017 issue of the Journal of the American Pharmacists Association reported that children and parents are receptive to medication counseling from pharmacists, but children are frequently not present during prescription pick-up.7 Obviously, if you’re going to help, you’ll need to get children to the pharmacy, so here are a few ideas:
- Show your pharmacy welcomes children – Parents may not be aware you’re available to counsel children, so tell them. Have small items to give kids, like the stickers or small toys pediatricians hand out. Educating children will take extra time, so you may want to set aside an hour once a month and advertise it as special time for parents and kids with asthma.
- Plan an event – Ask other health care providers to participate, whether pediatricians, allergists, pulmonologists, or pulmonary rehabilitation therapists. You’ll be the medication expert, but you’ll also need professionals with experience teaching children how to use an inhaler and who can discuss asthma action plans. Be sure to advertise the event.
- Make the event kid-friendly – Balloons, snacks, music, clowns—whatever you can envision that kids love and that you can get for free or at a discount.
- Have handouts for parents – Parents and children need handouts that show how to use inhalers, forms they can fill in to create an asthma action plan, and other informative handouts about asthma. You can find printable information online at the Palo Alto Medical Foundation’s web site8 and at the Allergy and Asthma Foundation of America.9
Pharmacists Improve Adherence By Teaching Inhaler Technique
It’s tough enough for children who have asthma, but then they end up facing further health risks because they don’t use inhalers or they don’t follow correct technique. Let’s face it, using an inhaler isn’t exactly easy for young kids, so there’s no doubt they need more instruction, encouragement, and support. It makes sense for pharmacists to offer this type of counseling when dispensing medications or at special events. You can be sure parents and children alike will benefit from your outreach.
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- “National Trends in Prevalence and Co-Morbid Chronic Conditions Among Children with Asthma, Autism Spectrum Disorder, and Attention Deficit Hyperactivity Disorder,” May 2016, http://www.abstracts2view.com/pas/view.php?nu=PAS16L1_2869.525 ↩
- “Comorbidities of Asthma in U.S. Children,” July 2016, https://www.ncbi.nlm.nih.gov/pubmed/27296818 ↩
- “Asthma Care: Quick Reference,” September 2012, https://www.nhlbi.nih.gov/files/docs/guidelines/asthma_qrg.pdf ↩
- “Asthma’s Impact on the Nation,” accessed January 2017, https://www.cdc.gov/asthma/impacts_nation/asthmafactsheet.pdf ↩
- “Adherence with Preventive Medication in Childhood Asthma,” April 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109699/ ↩
- “Asthma: Using a Metered-Dose Inhaler (MDI) with a Spacer,” January 2009, http://www.aboutkidshealth.ca/En/ResourceCentres/Asthma/AsthmaMedicines/Pages/Using-a-Metered-Dose-Inhaler-MDI-with-a-Spacer.aspx ↩
- “Pediatric Medication Use Experiences and Patient Counseling in Community Pharmacies: Perspectives of Children and Parents,” January 2017, http://www.japha.org/article/S1544-3191(16)30806-8/pdf ↩
- “Asthma Handouts,” accessed January 2017, http://www.pamf.org/asthma/education/handouts.html ↩
- “Asthma and Allergy Educational Materials and Tools for Patients and Caregivers,” accessed January 2017, http://www.aafa.org/page/programs-for-patients-and-caregivers.aspx ↩