Project Coversheet

Date of Award


Degree Type

DNP Project

Degree Name

Doctor of Nursing (ND)




Alejandra Valenzuela, DNP, APRN, CPNP-AC/PC


Background: Asthma is a serious disease that affects about six million children in the United States. Metered-Dose Inhalers with Spacer (MDI+S) devices and nebulizers (NEBs) are used to deliver inhalation medication. Although the MDI+S device has been recognized as a superior delivery system, about half of the patients that are prescribed these medications do not know how to use them resulting in poor asthma control. Observations from a reflective practice and an evidence-based literature review guided by the Ace Star Model, prompted a quality improvement (QI) project focused on children 5-11 years of age diagnosed with asthma, experiencing wheezing, and needing inhalation therapy.

Method: The QI project included implementing inhalation therapy using the MDI+S device with video education on its correct use to improve asthma symptoms. A form with QR codes linked to an educational video was provided to each patient. The Childhood Asthma Control Test (C- ACT) questionnaire designed for children 4-11 years was used to assess asthma symptoms both at pre and post intervention. A step-by-step checklist was used to evaluate MDI+S technique.

Results: All ten patients who completed this QI project exhibited improved C-ACT scores, had no wheezing, and demonstrated the proper technique using the MDI+S device. Limited impact on heart rate, fewer tremors, cost-effectiveness, and other benefits were also seen.

Discussion: Publications suggest that NEBs are effective for the treatment of pediatric asthma, however, the MDI+S device is generally considered superior for this indication. When properly used, it will lead to better asthma control and improve quality of life while being cost-effective.