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Evaluating inhaler education interventions for hospitalized children with asthma: a randomized controlled trial
Volerman A, Balachandran U, Zhu M, Akel M, Hull A, Siros M, Luna V, Xu I, Press VG
Annals of Allergy, Asthma, & Immunology 2023 Aug;131(2):217.e1-223.e1
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Most children with asthma have poor inhaler technique, with detrimental morbidity effects. Guidelines recommend clinicians provide inhaler education at every opportunity, yet resources are limited. A low-cost, technology-based intervention-Virtual Teach-to-Goal (V-TTG)-was developed to deliver tailored inhaler technique education with high fidelity. OBJECTIVE: To evaluate whether V-TTG leads to less inhaler misuse among children with asthma who are hospitalized versus brief intervention (BI, reading steps aloud). METHODS: A single-center randomized controlled trial of V-TTG versus BI was conducted with 5- to 10-year-old children with asthma hospitalized between January 2019 and February 2020. Inhaler technique was assessed pre- and post-education using 12-step validated checklists (misuse < 10 steps correct). RESULTS: Among 70 children enrolled, mean age was 7.8 years (SD 1.6). Most (86%) were Black. Most had an emergency department visit (94%) or hospitalization (90%) in the previous year. At baseline, nearly all children misused inhalers (96%). The proportion of children with inhaler misuse decreased significantly in V-TTG (100% to 74%, p = 0.002) and BI (92% to 69%, p = 0.04) groups, with no difference between groups at both time points (p = 0.2 and 0.9). On average, children performed 1.5 more steps correctly (SD 2.0), with greater improvement with V-TTG (mean (SD) 1.7 (1.6)) versus BI (mean (SD) 1.4 (2.3)), though not significant (p = 0.6). Concerning pre and post technique, older children were significantly more likely than younger children to show more correct steps (mean change 1.9 versus 1.1, p = 0.002). CONCLUSION: A technology-based intervention for tailored inhaler education led to improved technique among children, similarly to reading steps aloud. Older children saw greater benefits. Future studies should evaluate the V-TTG intervention across diverse populations and disease severities to identify the greatest impact. CLINICAL TRIAL REGISTRATION: NCT04373499.

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