Dry Powder Inhaler Use in Primary School Aged Children with Asthma: A Systematic Review

Objective Asthma is the most common chronic disease in children. Dry powder inhalers (DPI) are effective for medication delivery in adults and adolescents, and provide a lower environmental footprint and more portability when compared to metered dose inhaler (MDI) with spacer. They require specific technique, and it is necessary to ascertain whether they can be used in younger age groups. We aimed to assess evidence regarding whether primary school aged (5–11 years) children can use DPI with adequate technique both during stable and acute asthma. Design Ovid MEDLINE, Embase and PubMed were searched for studies assessing DPI use in children aged 5–11 years with asthma or wheeze. Results of studies were synthesised by study design and outcome measure. Results Thirty-eight studies were identified for analysis. These were analysed in three groups: (1) 25 studies assessing children's ability to use DPI by peak inspiratory flow measurement, (2) 10 studies assessing children's ability to use DPI by physician assessment, and (3) three studies measuring efficacy of DPI compared to gold standard (MDI with spacer). Five studies included children during acute exacerbations. Conclusion The majority of primary school aged children have the ability to use a DPI with adequate training, support and practice. Some younger children may have difficulties, and clinician assessment and ongoing review is crucial in determining which children are likely to benefit from a DPI. Consistent correct use and adherence remains a challenge, but this is also an issue with MDI plus spacer and does not appear to be significantly worse with DPI. Evidence of the use of DPI during acute illness is limited, and more studies are required in this setting.