What is the best education to provide to the mother of a child with asthma and frequent Upper Respiratory Tract Infections (URTI) to prevent recurrence of acute asthma exacerbations?

Best Education for Mother of Child with Asthma and Frequent URTIs

The most critical education to provide is teaching proper inhaler technique, as this directly impacts medication delivery and prevents recurrent exacerbations, with studies showing that less than 50% of children use inhalers correctly without proper training. 1, 2

Primary Educational Priority: Inhaler Technique Training

Teach the mother and child correct metered-dose inhaler (MDI) technique with spacer device, as this is the cornerstone of preventing acute exacerbations. 1

• The National Asthma Education and Prevention Program explicitly recommends that patients be educated on correct inhaler use at discharge and that this education should be reinforced at every clinical visit 1
• Only 8.1% of children perform all MDI steps correctly without proper instruction, making this a critical gap in asthma management 3
• Proper inhaler technique is essential because the child requires a short-acting bronchodilator for acute symptoms and likely needs daily inhaled corticosteroids for persistent asthma 1

Key Components of Inhaler Education:

• Demonstrate the technique yourself first, then have the child demonstrate back to you until they achieve mastery 1
• Use a spacer device with MDI - technique is significantly better when children use spacers, and this should be standard practice 4
• Check technique at every visit - the majority of providers fail to assess or demonstrate device technique during asthma visits, contributing to poor control 3

Secondary Educational Components

Written Asthma Action Plan

Provide a written asthma management plan that includes specific instructions for when to increase medications or seek emergency care. 1

• The plan should specify when to self-administer oral corticosteroids (when peak flow falls below 60% of personal best or symptoms worsen progressively) 1
• Include clear triggers for seeking urgent medical attention 1
• Give copies to all caregivers and the child's school 1

Understanding Medication Roles

Educate on the difference between "reliever" (bronchodilator) and "preventer" (inhaled corticosteroid) medications. 5

• Explain that daily long-term control medications (inhaled corticosteroids) are necessary to prevent exacerbations in persistent asthma 1
• If the child is using more than one canister of short-acting bronchodilator per month, daily controller therapy should be initiated or increased 1

URTI-Specific Management

Since viral URTIs are the most common trigger for asthma exacerbations in children, teach early recognition and response. 6

• Viral respiratory infections are the predominant trigger for asthma exacerbations in children under 5 years 6
• Consider providing a prescription for oral corticosteroids to be initiated at the earliest onset of URTI symptoms, though recognize that parent uptake may be limited by uncertainty 7
• Increase inhaled corticosteroids at the first sign of URTI-related symptoms 1

Environmental Control Measures

While environmental control is important, it is secondary to ensuring proper medication delivery through correct inhaler technique. 1

• Identify and avoid specific triggers where possible 1
• Address smoking exposure if present 1
• However, environmental control alone without proper medication use will not prevent exacerbations 1

Common Pitfalls to Avoid

• Do not simply hand the family an inhaler without demonstration - this results in less than 50% correct technique 2
• Do not assume the child knows how to use the inhaler correctly - even if previously instructed, technique deteriorates over time without reinforcement 4, 3
• Do not focus solely on nebulizer teaching - while nebulizers may be used for acute exacerbations, proper MDI with spacer technique is essential for daily management and is more practical for home use 1, 4
• Avoid overreliance on bronchodilators without anti-inflammatory treatment - this is associated with increased asthma mortality and morbidity 1, 5

Follow-Up Requirements

Schedule a follow-up appointment within 24-48 hours after any acute exacerbation to reassess control and reinforce education. 5

• Regular review of inhaler technique is mandatory at every visit 1, 5
• Monitor for signs that daily controller therapy needs to be initiated or increased (frequent symptoms, nighttime awakening, activity limitation) 1, 6