Comparative Efficacy of Two Inhalational Techniques when Using a Pressurized Meter Dose Inhaler with Valved Holding Chamber in Children with Asthma: A Randomized Controlled Trial

Introduction: Inhaled medication delivered through a pressurized metered dose inhaler (pMDI) with a valved holding chamber (VHC) is the optimal treatment for asthma. The best technique is the breath-holding (BH) technique. Tidal breathing (TB) technique is also recommended by Global Initiative for Asthma (GINA) as an alternative. Clinical studies have shown variable results, but the scintigraphy study shows better lung deposition with the BH technique. The present study was designed to address the shortcomings in previous studies and to confirm the scintigraphy study findings by comparing the two techniques. Methods: This randomized controlled trial included children aged 5-14 years with nonsevere asthma not taking inhaled medications on entry to the study, but during the study, they were given inhaled medications by pMDI + VHC (according to GINA guidelines) over an 8-week period. Demography, clinical details, spirometry parameters, and asthma control were recorded/assessed. The primary outcome was change in spirometry parameters at 2 and 8 weeks. Results: Eighty-two children (mean age: 8.64 years, 46 boys) were included. There was no intergroup difference in the spirometry parameters and asthma control scores at any point in time (p > 0.05). A significant intragroup improvement was noted only for forced expiratory volume in the first second at 8 weeks (p < 0.05). Similarly, a significant intragroup improvement in asthma control score was noted at 8 weeks (p < 0.05). No adverse event was noted in either of the groups. Conclusions: The present study found no difference between the BH and the TB techniques while delivering aerosols through a pMDI with a VHC. Either the BH or the TB technique may be used in children (5-14 years) with nonsevere asthma.