Inhaler Technique in Children With Asthma: A Systematic Review

Acad Pediatr. Sep-Oct 2016;16(7):605-15. doi: 10.1016/j.acap.2016.04.006. Epub 2016 Apr 26.


Background: Pediatric asthma is an important public health problem worldwide. The primary methods of medication delivery are inhalation devices.

Objectives: This systematic review examined: 1) what is the prevalence of correct inhaler technique among children with asthma, 2) are educational interventions associated with improved rates of correct inhalation technique, and 3) is improved inhaler technique associated with improved asthma outcomes?

Data sources: We included experimental and observational studies through searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, and

Study eligibility criteria, participants, and interventions: Studies were eligible for this review if at least 1 outcome measure of the study included and reported results of child/adolescent inhaler technique.

Study appraisal and synthesis methods: The following information was extracted from each included study: study design (experimental vs observational), and outcomes data. The Downs and Black checklist was used to appraise study quality.

Results: Twenty-eight studies were eligible for inclusion. We found that inhaler technique is generally very poor among children, but is better when children use their metered-dose inhalers (MDIs) with spacers. Technique in using turbuhalers and diskus inhalers is better than in MDI, but still poor. Counseling children on correct inhaler technique was associated with improved technique among children in multiple studies.

Limitations: We examined articles published in English.

Conclusions and implications of key findings: Inhaler technique in children is generally poor. Physicians and other members of the health care team should instruct children and their caregivers on the proper use of their inhalation devices at every opportunity and correct mistakes when made to ensure effective medication delivery.

Registry: This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO CRD42015025070 (

Keywords: adolescent; asthma; bronchodilator agents; child; dry powder inhalers; inhalation spacers; metered-dose inhalers.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Asthma / drug therapy*
  • Bronchodilator Agents / administration & dosage*
  • Child
  • Humans
  • Inhalation Spacers
  • Metered Dose Inhalers*
  • Nebulizers and Vaporizers


  • Bronchodilator Agents