Two vs four puffs of albuterol: does dose change bronchodilator response?

Assisting Students With Asthma Inhaler Technique and Knowledge

Proper inhaler use is critical to asthma management, but many children and youth do not use their inhalers correctly. School nurses are ideally positioned and have an important role in assessing the inhaler technique and knowledge regarding its use among students. This article discusses common student errors with inhaler technique, along with knowledge deficits surrounding use of asthma inhalers. A tool for assessing inhaler use is provided, in addition to suggestions for how to assist students with improved inhaler technique. By assessing inhaler technique and knowledge early in the school year, school nurses proactively assist in improved student management of their asthma.

Impulse oscillometry: pulmonary function assessment in preschool children

OBJECTIVES

In contrast to spirometry, which requires active participation of the individual and is challenging for the preschool age group, the impulse oscillometry system comprises a test that minimizes the degree of coordination required. The study aimed to compare the results of Impulse Oscillometry System (IOS) in children with and without respiratory symptoms.

METHODS

A cross-sectional study was conducted in children aged between 3 and 6 years. A short version of the ATS-DLD-78-C questionnaire validated for Brazilian children was applied to identify two groups: children with and without respiratory symptoms. The IOS analysis was carried out measuring the following parameters in triplicate: resistance at 5 Hz (R5Hz) and 20 Hz (R20Hz), respiratory reactance at 5 Hz (X5Hz), and R5-R20Hz before and after bronchodilator application.

RESULTS

A total of 76 preschoolers were selected, 55 (72.4%) of whom had respiratory complaints. The coefficient of variability of R5Hz was ≤17% in 70/76 (92.1%) of the children. Resistances at R5Hz and R5-R20Hz in the children with respiratory complaints reached values higher than those of children without symptoms before bronchodilation.

CONCLUSIONS

The results obtained for resistance using IOS in children with respiratory symptoms were higher in the pre-bronchodilator examination for R5Hz and R5-R20Hz compared to those of children without respiratory symptoms.

EXPERT OPINION

Prospective investigations suggest that irreversible changes in lung function begin in infancy, before reaching school age. Pulmonary function follow-up in children with recurrent wheezing or asthma is important for confirmation of diagnosis and evaluation of the disease severity. The Impulse Oscillometry System (IOS) can be useful in assessing children's pulmonary function since it requires minimal patient cooperation and can be successfully applied to preschool children being an alternative to individuals who have difficulty performing spirometry.