Date of Award

2006

Degree Type

Thesis

Degree Name

Bachelor of Science Honours

Faculty

Faculty of Computing, Health and Science

First Advisor

Dr Sunalene Devadason

Second Advisor

Dr Angus Stewart

Abstract

Incorrect inhaled drug delivery technique is a common problem in paediatric asthma [1-4]. Previously, device technique training has been shown to significantly improve inhaler skills, using subjective methods, namely check-list analysis [5-8]. However, more objective measures are needed to examine more comprehensively the effect of training in preschool children and parents. Resistance to regular asthma therapy is also a frequent problem when attempting to treat young children. Reasoning with young children can be very difficult and parents often have to struggle with their child to achieve compliance [2]. The Funhaler spacer (FH) (Funhaler™; InfaMed, Australia) has been developed in an attempt to resolve this issue by incorporating incentive toys to distract the child from the drug delivery process. Based on parental questiom1aire, the FH has been shown to improve inhalation technique and increase medication compliance in young children over a two-week period [1]. A total of 47 children participated in the present study; 24 were randomised to a standard Aerochamber plus spacer (AC+) (15 male, mean age 63.7 months, range 30- 90 months), and 23 were randomised to the FH spacer (14 male, mean age 60.5 months, range 36-90 months). Of the 47, four children (AC+: n=2, FH: n=2), with a mean age of 51 months (36-60 months) were identified as nose breathers, and were analysed as a separate group. The results from the present study show that repeated clinic-based technique training had no significant effect on drug delivery (p=0.l51). Furthermore, it was found that in the clinic setting, children who were using the FH spacer were more likely to 'play up' during the drug administration procedure, compared to children using the AC+ spacer. This was also reflected in the domiciliary setting, where children who were using the AC+ spacer exhibited significantly higher drug delivery consistently over the seven days, compared to the FH spacer group (p=0.032). In addition, the in vitro data showed that drug delivery was significantly dependent on age, height, weight and breathing parameters (peak inhalation flow, tidal volume, inhalation volume, exhalation volume, peak exhalation flow) with the AC+ spacer; however this was not seen with the FH spacer. Although it was expected that dependence on parameters such as inspiratory volume would affect day-to-day drug dose, it was found that drug delivery was actually better in the home setting with the AC+ spacer than the FH spacer. Therefore, these findings suggest that children interact better with a standard spacer device, such as the AC+, compared to the incentive FH spacer.

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