Improving Asthma Control in Children Using the Teach-to-Goal Method

Jodi Root; Leigh Small


Pediatr Nurs. 2019;45(5):250-257. 

In This Article

Abstract and Introduction


Background: Asthma medications should be used correctly to be effective. Incorrect pressurized metered dose inhaler valved holding chamber (pMDI-VHC) technique results in inadequate asthma control.

Problem: Reports indicate nearly 80% of individuals with asthma do not use inhalers correctly, and 67% of providers who care for individuals with asthma cannot demonstrate correct device technique.

Methods and Interventions: This quality improvement project was initiated to improve child asthma control by teaching correct pMDI-VHC technique. Prior to initiating the project, the providers engaged in a brief educational session regarding the six-step technique for proper pMDI-VHC use to promote consistent education of participants. A pre/post project design was used to assess the effect of a six-step educational/skill-building intervention. Children age 7 to 11 years with persistent asthma and able to perform Pulmonary Function Testing (PFT) and pMDI-VHC technique (N = 35) were included. The Childhood Asthma Control Test (C-ACT) and the Mini Pediatric Asthma Quality of Life Questionnaire (MiniPAQLQ) assessed the child's asthma control and quality of life at three time points (T1, T2, T3). PFTs were completed at baseline and T3 to appreciate the effects of the intervention on lung function.

Results: We identified statistically significant improvement in child asthma control and quality of life outcomes (C-ACT p = 0.000 and MiniPAQLQ p = 0.004) and a small effect on pulmonary function (pre-FEV1 d = 0.124; pre-FEF25–75 d = 0.040).

Conclusion: Participants demonstrated significant improvement in recall of correct pMDI-VHC steps and technique at each successive project time point, and self-reported asthma control also improved. Children and their parents who are taught this method of proper inhaler use in primary clinical settings may experience similar improvements in child asthma control as observed in this project.


Asthma is a common chronic illness in the United States, with a prevalence of 8.4% in children less than 18 years of age (Centers for Disease Control and Prevention [CDC], 2019). In a 2014 asthma surveillance report, children in California had an asthma prevalence of 9.4% and when assessed by specific age groups, children aged 5 to 17 years old had the highest asthma prevalence at 14% (California Department of Public Health, [CDPH], 2017). However, in some California counties, the average asthma prevalence is greater than 25% (UCLA Center for Health Policy Research, 2018). This suggests that improved asthma control among children in central California should be a priority health outcome for the state.

Research identifies a significant issue in asthma management is incorrect use of inhaled medications and associated devices (i.e., valved holding chambers [VHCs]) (Baddar, Jayakrishnan, & Al-Rawas, 2014; Sanchis, Gich, & Pedersen, 2016). The Global Initiative for Asthma (GINA) estimates that up to 80% of individuals with asthma and 67% of health care providers cannot demonstrate correct inhaler technique (GINA, 2016, 2019); The consequences of incorrect technique include poor medication deposition in the lungs, frequent asthma symptoms, emergency department (ED) visits, hospital admissions, and systemic corticosteroid use (Gillette, Rockich-Winston, Kuhn, Flesher, & Shepherd, 2016; Goodwin, & Heraghty, 2015; Harnett et al., 2014; Normansell, Kew, & Mathioudakis, 2017; Türkeli, Yilmaz, & Yüksel, 2016). Health care providers who care for patients with asthma should prioritize appropriate pMDI-VHC patient education to mitigate this health disparity and improve child asthma control.