Asthma is a Greek word which means breathless or to breathe with open mouth.

Asthma is a lung disease that is characterized by inflammation, obstruction, and hyper responsiveness of the airway.(1) Asthma is a leading cause of chronic illness in childhood, responsible for a significant proportion of school days lost because of chronic illness. As many as 10-15%boys and 7-10 % girls may have asthma at some times during childhood. Before puberty twice as many boys as girls are affected, thereafter the sex incidence is equal (3) Although data of allergic diseases in India is scarce, the limited data that is available suggests that patterns of incidence differ in different areas. Chakravarthy et al. (2002) reported 9 % prevalence of breathing difficulty from rural areas of Tamil Nadu in another study from rural areas of North India, the prevalence of chronic cough among children was 1.06% and out of these two thirds was due to asthma(Singh et al.,2002). In a recent study conducted at Chandigarh (India), under the aegis of the Asthma Task Force of the Indian council of medical Research, the prevalence was found to be 3.3 % for asthma, and other atopic diseases in randomly selected schools. Such national variation with almost 10-15 fold difference in the prevalence of allergic disorders is probably unique to India(Asher et al.,2006).this variation can be due to population differences or risk factors associated to that particular area. Manzella et al11 have developed a set of 10 skill items for measuring proper use of the metered-dose inhaler (MDI). Byron PR.(1990)The major role of inhalers in the management of asthma and other respiratory disorders has only developed over the past 40 years.2 The introduction of the pressurized metered-dose inhaler (pMDI) in 1956 allowed for effective portable aerosol administration for the first time. The development of progressively

more specific and effective anti-asthma therapy, and of new forms of inhalers during the 1970s and 1980s, lead to many potential improvements in quality of life for the typical patient with asthma. NEED OF STUDY Asthma is a most common childhood disease with significant impact on morbidity and mortality[3]. ) In spite of significant advances in the understanding of disease and its management, morbidity and mortality from asthma is still high. The important reasons for this are under treatment with steroids, limited knowledge and poor asthma management skills among patients with severe asthma.(4) The increase of morbidity is reflected in days lost from school, worsening quality of life, increased hospitalization rates, increased intensive care admission, and increased emergency department visits.(5) The cornerstone of the daily control of asthma is inhaled therapy. Inhaled corticosteroids, when properly used, can offer considerable protection against asthma-related morbidity.[6] In this respect , direct delivery of the aerosolized drug in the lower airways is advocated to treat inflammation and to relieve obstruction. In comparison with oral therapy, the inhaled pathway allows the minimization of effective doses and consequently minimization of adverse systemic effects, particularly important for long term treatments often necessary in asthma. On the other hand, several variables affect the inhaled pathway, mostly related to the drug formulation and delivery device. Pharmacological treatment of asthma require a step wise approach based on the severity o the disease, which can be adapted continuously according to the clinical control of the disease. The ultimate goal of treatment is to achieve and maintain control of clinical symptoms for extended periods with the least possible amount of drugs [7]