The impact of different counseling techniques on children asthma control

Background: Children asthma control complex due to the chronic nature of asthma and its interference with children’s quality of life, patient counseling about asthma nature and inhaler use are considered the cornerstone in asthma control. We evaluated various patient counseling techniques for optimizing the use of pressurized metered dose inhalers (pMDIs) to enhance asthma medication delivery and asthmatic state. Methods: A random cohort of nonsmoking children with asthma aged 11-19 years was collected from an outpatient clinic; all diagnosed using Global Initiative for Asthma (GINA) diagnosis guidelines. The patient's asthma status and pMDI use were assessed during the initial structured interview, and three groups were randomly divided for different counseling techniques, as the following, traditional verbal counseling only was applied to Group 1, while Group 2 received advanced counseling just via two smartphone applications without verbal corrections for inhaler use errors and Group 3 received the advanced counseling using two smartphone applications alongside with verbal correction of the inhaler use mistakes. We monitored the three groups for two consecutive months using the forced expiratory volume in the one second to the forced vital capacity of the lungs ratio (FEV1/FVC) ratio, Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), and GINA control assessment Questionnaire. Results: A total of 102 children with asthma n=102 were divided in to three counseling groups, each group is consisted of 34 patients, n=34. We found that, in term of FEV1/FVC 2nd month interview, the advanced verbal counseling group was superior to the advanced alone counseling group p=0.016. In term of ACT 2nd month interview, the advanced verbal counseling group was superior to the verbal only counseling group p=0.023. In term of ACQ 8th week interview the advanced alone counseling group was superior to the verbal alone counseling group p=0.018. From the 2-month follow-up course using FEV1/FVC ratio, ACT, ACQ, and GINA control assessment questionnaires, the three counseling techniques significantly improved asthma control for all groups p<0.001. Conclusion: The combination of smartphone applications based advanced counseling alongside with the verbal correction of the inhaler use errors resulted in a better children asthma control than using a single counseling approach.