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.
Results: 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.