Good asthma control, taking medications as prescribed and using inhalers correctly, remains more vital than ever for children with asthma as shielding rules are relaxed across the UK. Studies show that up to 90% of people will make a mistake when using their inhaler – many of these will be critical errors significantly impacting the amount of medication reaching the lungs.
Dr Clare Murray, Consultant in Paediatric Respiratory Medicine at Royal Manchester Children’s Hospital, says, “For children prescribed steroid inhalers it is vitally important that this is given exactly as prescribed and there isn’t over-reliance on the reliever inhaler. However, the medication needs to reach the lungs and not just be deposited in the mouth, as this can lead to side-effects. Therefore, it is really important, that for young children inhaled medicines are given with a spacer to ensure that as much as possible reaches the lungs.”
A newly-validated app, called Rafi-Tone, allows parents to log and monitor each inhaler use, to help them to ensure that their child is taking their medication as prescribed. It has also been designed to help young inhaler users to overcome the distress associated with using an inhaler and spacer.
Asthma UK advises parents that using the correct inhaler and spacer technique reduces their child’s risk of asthma symptoms and potentially life-threatening asthma attacks[i]. However, it is often difficult for children, especially those who are very young, to understand the importance of taking their inhaler medication, and how to properly use an inhaler. Spacer masks can help to ensure that children with asthma take their medication correctly, but many children find the mask, which covers their mouth and nose, frightening.
Most inhaler technique reviews are conducted by healthcare professionals, many of whom have been unable to accurately assess technique over the phone or by video chat during remote consultations. The Rafi-Tone app has been clinically validated, and so parents and healthcare professionals can be confident that it is encouraging the correct technique and providing clear, objective advice.
Independent Queen’s Nurse Heather Henry, who has been working closely with children with asthma and their families since 2016, says, “In my experience, the youngest children, those of pre-school age, are the ones who struggle the most to use a spacer inhaler to take their medication. Most of them really do not like to have a mask over their face, and this can be extremely upsetting not only for them, but for their families. Children pick up on any anxiety or distress from their parents, and so it is very easy to get into a cycle of distress when it comes to taking asthma medication.”
Heather continues, “This is where apps like Rafi-Tone and devices to make the process fun and engaging can really help. Learning through play is a really effective way for children to start learning about their condition, and the enjoyment aspect is hugely reassuring for parents. There are an awful lot of apps out there, but there are very few that are evidence-based and have clinical backing. I would always refer parents to the NHS App Library as the best resource for finding clinically-proven apps.”
The Rafi-Tone was originally developed by a University academic, Professor Tariq Aslam, to help his son, Rafi, by using specially designed games and cartoons to encourage and monitor correct inhaler technique. Rafi Robot, the star of the app, helps to engage the child whilst promoting effective inhaler technique through a series of fun games.
A 2019 study found that the Rafi-Tone app has a significant impact on children’s acceptance of their inhaler medication, which could lead to an improvement in reported symptoms and a reduction in A&E and GP appointments[ii].
In large studies, 51% of children reported becoming upset when using their standard spacer, but this reduced to only 22% by switching to the Rafi-tone system. Similarly, the number of parents confident that the spacer had delivered the right dose more than doubled from 42% to 89%. The study also saw improvements in children’s own perceptions, and strong endorsement from independent specialist nurses who took part in the study.