Assessment of inhaler technique and adherence to ICS
All carers were shown how to use their child’s inhaler with a spacer
correctly. They were all given a written personalised wheeze plan with
clear instructions about when the treatment should be administered. All
families were issued with an electronic monitoring device at the
baseline visit (Smartinhaler®; Nexus6 Ltd, Auckland, New Zealand).
Smartinhalers were available for beclomethasone diproprionate,
fluticasone proprionate and Seretide (fluticasone proprionate plus
salmeterol combination inhaler) metered dose inhalers (MDIs). The
devices contain a microchip that records the date and time the inhaler
is actuated. Participants and their guardians were informed that the
Smartinhaler would record the total number of actuations of ICS per day.
Adherence was defined as the percentage of controller medication doses
taken relative to the number of doses prescribed. Adherence was defineda priori as a ratio of doses taken; good adherence ≥80%,
moderate adherence 60-79% and poor adherence <60%[10].
Daily adherence was calculated with a maximum of 100%, to avoid falsely
increased values due to dose dumping.