The use of inhaled drugs in the population of Polish pediatric patients suffering from bronchial asthma

Introduction
Inhalation drugs are the basis for both acute and chronic treatment of children with bronchial asthma. The choice of the method of aerosol therapy belongs to the physician who is responsible for the treatment and what should be considered is patient’s age together with understanding and willingness to follow orders, physical and mental capabilities, cooperation and the possibilities, skills and willingness of its guardians. To obtain a control of the disease it is necessary to provide training of the patient and his caregiver before starting the treatment and later during chronic treatment – regular control of the method of medication inhalation. It is equally important to transfer this knowledge to caregivers who will control the baby’s aerosol therapy at home. Their understanding and acceptance of a given inhalation system depends on therapeutic success.

Aim of the research
This study aimed to obtain information on what methods of aerosol therapy are used in Polish pediatric patients with asthma, whether children and caregivers are using aerosol therapy techniques properly and what proportion of patients (and their guardians) has been trained by medical staff in this regard.

Material and methods
Research was conducted in the form of a survey. Two versions of the questionnaire had been created (for parents of children aged 0–5 years and for children of 6 years and above). For the purpose of the study, parents and children completed the survey during the hospitalization in the Clinic of Allergology and Pneumonology of the Institute of Tuberculosis and Lung Diseases in Rabka-Zdroj from February 2016 to November 2018. One of the survey questions concerned the fact that parent or a child completed a Childhood Asthma Control Test (C-ACT) and other questions concerned the knowledge of the PEFR peak expiratory flow meter (“peak flow meter”, “pefrometer”).

Results
Parents of 82 patients aged 0–5 (51 boys, 31 girls) and parents of 128 patients ≥ 6 years old (63 boys, 65 girls) took part in the survey. The data were obtained from the analysis of 210 questionnaires. The average age of diagnosis of bronchial asthma was 4 years and 7 months (younger group) and 5 years and 1 month (older group). Some of the questions were open (regarding the medicines and commercial names of inhalers and inhalation chambers), most in a closed form (single or multiple choice from several options). Over 93% of patients declared short-acting β-mimetic drugs (SABA). In the group of children aged 0–5 years, it was administered to patients on an ad hoc basis in nebulization (52.4%), and via pressure inhalers pMDI (62.2%) (several answers could be selected). In the group of children ≥ 6 years 34% of patients use SABA drugs in nebulization, 46.9% by pMDI and 18.8% by powder inhalers. In the group 0–5 years inhaled drugs in a chronic nebulization are taken by 52.4% of patients, whereas in the group of ≥ 6 years 25% take it in nebulization, 43% from the pMDI pressure inhaler, and 32% from the DPI dry powder inhaler. In the group of ≥ 6 years of age 67% of patients use a nebulizer with a facial mask and in the group of 0–5 years 74.4% of patients. In the group of younger children, 84.3% of children use inhalants in the pMDI inhaler through the inhalation chamber, and in the group of older children 71.2%, where the chamber with the mask instead of the mouthpiece is used by 29% in this group. Powder inhalers (disc, turbuhaler and easyhaler) are used in older children in 28%, 32%, 32% respectively, while the aerolizer in 8%. Forty-one percent of parents of children aged 0–5 years and 55.5% of parents of children ≥ 6 years old were trained in the use of an inhalation chamber; 47.5% of parents of younger children (0–5 years) and 66.4% of parents of older children (≥ 6 years) regarding the use of current inhaler. 92.7% of younger children and 86.2% of older children do not regularly show their doctor how they use inhaled medicine; 74.4% of younger children and 71% older children have never shown this to their doctor. PEFR has never been seen or used by 81.3% of older children. A total of 60.7% of children ≥ 6 years of age and 38.8% from the group of 0-5 years consider asthma to be well and fully controlled. The C-ACT standardized pediatric asthma control questionnaire was completed previously (before participation in the study) by only 17% of patients ≥ 6 years (or their caregivers).

Conclusions
Education of children with asthma and their caregivers in the proper technique of administering inhalation drugs to the respiratory system is insufficient in Poland. Medical staff rarely demonstrates to patients how to use inhalers, do not monitor and do not routinely repeat education in techniques of inhalation during follow-up visits, and the pediatric asthma control test (C-ACT) in children is not commonly used.