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.