An observational study of quick-relief inhaler storage and use among children with asthma in home, school, and community

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Abstract
Background: For children with asthma, access to and use of quick-relief inhalers can be life-saving. Children must have access and ability to use inhalers across home, school, and community settings. This study aimed to examine how children store and use inhalers across settings and evaluated the relationship to asthma control and exacerbations. Methods: This cross-sectional study recruited participants 10–17 years with asthma from clinics affiliated with one urban academic medical center. Children completed a questionnaire with questions about quick-relief inhaler storage and use within home, school, and community settings as well as asthma control and exacerbations. Responses were categorized by whether storage or use were independent or not independent. Kendall's Tau was calculated to assess correlation between children's independence of inhaler storage and use across settings. Chi-squared and Fisher's exact tests examined their association with asthma control and exacerbations. Results: Among 90 enrolled children, 53% ( N = 48) were male and 67% ( N = 60) were non-Hispanic Black. Mean age was 13.1 years (SD = 2.2). At home, 52% ( N = 47) of children reported independently storing quick-relief inhalers and 54% ( N = 48) independently used inhalers. At school, 60% ( N = 54) of children indicated they independently stored inhalers while 82% ( N = 74) independently used inhalers. In the community, 90% ( N = 81) of children reported independently storing inhalers. Within settings, there was moderate correlation between independent inhaler storage and use. Across settings, independent inhaler use was moderately correlated between home and school; however, independent storage of inhalers was not correlated. Also, inhaler storage and use was not associated with asthma control or exacerbations. Conclusions: This observational study is among the first to describe quick-relief inhaler storage and use by children across settings, showing variation in practices. Although we found storing and using quick-relief inhalers independently were correlated at home and school, they were not associated with asthma control or exacerbations. These findings help identify patterns related to asthma self-management and highlight opportunities for collaboration between clinicians, caregivers, and children to support developmentally-appropriate asthma care across settings.

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