Inhaler Technique Questionnaire (InTeQ) in pediatric patients with asthma

Abstract

This study aimed to assess the validity and reliability of the Inhaler Technique Questionnaire (InTeQ) in children and adolescents with asthma. A prospective, multicenter, observational study was conducted within the Asthma Research in Children and Adolescents (ARCA) cohort in Spain. Participants aged 6–14 years with asthma who had received inhaled corticosteroid treatment were included. The InTeQ was administered through computer-assisted telephone interviews and assessed the frequency with which participants performed five key steps of inhaler use. Its structural validity was evaluated using Mokken scaling analysis, while reliability was assessed using Cronbach’s alpha. Construct validity was examined according to asthma control and spacer use, and criterion validity was assessed by comparing patient-reported technique with face-to-face observation by pediatricians. Of 323 participants who completed the baseline interview, 319 completed the InTeQ. The questionnaire showed evidence of unidimensionality with four items and acceptable reliability. It demonstrated good construct validity, with significant differences according to asthma control and spacer use. However, agreement between patient-reported inhaler technique and expert observation was poor, as most participants reported frequently performing the inhalation steps correctly, whereas none of the 37 participants observed performed all steps correctly. The findings indicate that the InTeQ is a feasible, reliable, and valid instrument for assessing inhalation technique in children and adolescents with persistent asthma. Combining patient self-report with direct observation may help healthcare professionals identify specific aspects of inhaler technique that require improvement.