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Educational inhaler technique interventions in asthma & COPD patients

Sven L. Klijn1, Mickael Hiligsmann1, Silvia M.A.A. Evers1, Miguel Román-Rodríguez2, Thys van der Molen3 and Job van Boven3,4
1Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands, 2Son Pisa Primary Health Care Centre, Balearic Health Service, Palma de Mallorca, Spain, 3Department of Primary Care, University Medical Center Groningen, Groningen, Netherlands, 4Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, Netherlands


Background Suboptimal inhaler technique is an important reason of poor health outcomes in asthma & COPD patients. Various educational interventions to improve inhaler technique have been developed, yet the key characteristics of successful interventions have not been identified.

Aims We aimed to systematically review RCTs of educational inhalation technique interventions to assess overall effectiveness and key success factors.

Methods The MEDLINE, EMBASE and CINAHL databases were searched for RCTs on educational interventions to improve inhaler technique in asthma and COPD patients. Inclusion eligibility and quality appraisal (Cochrane Collaboration's risk of bias tool) were performed by two independent reviewers. Characteristics of the education (e.g. setting, provider, group size and time), study population, inhaler type, and outcomes were systematically extracted. Regression analyses were performed to identify key characteristics contributing to inhaler technique improvement.

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Thirty-seven of the 39 included studies showed statistically significant improvement of inhaler technique for educational intervention groups compared to control. Poor initial technique, setting, and time elapsed since intervention (all, p<0.05), were shown to have a significant impact on effectiveness of the intervention, explaining up to 91% of the effectiveness variation. Other factors, such as disease, group size, and inhaler type did not play a statistically significant role.

Conclusion This study suggests that educational interventions to improve inhaler technique are generally effective, especially in patients with poor initial technique. However, they should be reinforced over time.

Sumber :

PDPI Jatim. 09/02/18.

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