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Review
. 2017 Apr 13;27(1):24.
doi: 10.1038/s41533-017-0022-1.

Effectiveness and Success Factors of Educational Inhaler Technique Interventions in Asthma & COPD Patients: A Systematic Review

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Free PMC article
Review

Effectiveness and Success Factors of Educational Inhaler Technique Interventions in Asthma & COPD Patients: A Systematic Review

Sven L Klijn et al. NPJ Prim Care Respir Med. .
Free PMC article

Abstract

With the current wealth of new inhalers available and insurance policy driven inhaler switching, the need for insights in optimal education on inhaler use is more evident than ever. We aimed to systematically review educational inhalation technique interventions, to assess their overall effectiveness, and identify main drivers of success. Medline, Embase and CINAHL databases were searched for randomised controlled trials on educational inhalation technique interventions. Inclusion eligibility, quality appraisal (Cochrane's risk of bias tool) and data extraction were performed by two independent reviewers. Regression analyses were performed to identify characteristics contributing to inhaler technique improvement. Thirty-seven of the 39 interventions included (95%) indicated statistically significant improvement of inhaler technique. However, average follow-up time was relatively short (5 months), 28% lacked clinical relevant endpoints and all lacked cost-effectiveness estimates. Poor initial technique, number of inhalation procedure steps, setting (outpatient clinics performing best), and time elapsed since intervention (all, p < 0.05), were shown to have an impact on effectiveness of the intervention, explaining up to 91% of the effectiveness variation. Other factors, such as disease (asthma vs. chronic obstructive pulmonary disease), education group size (individual vs. group training) and inhaler type (dry powder inhalers vs. pressurised metered dose inhalers) did not play a significant role. Notably, there was a trend (p = 0.06) towards interventions in adults being more effective than those in children and the intervention effect seemed to wane over time. In conclusion, educational interventions to improve inhaler technique are effective on the short-term. Periodical intervention reinforcement and longer follow-up studies, including clinical relevant endpoints and cost-effectiveness, are recommended.

Conflict of interest statement

Mr. S.K. reports current employment (Pharmerit International), during the study he was a student at Maastricht University. Dr. M.R.R. reports personal fees from Astra Zeneca, personal fees from Boehringer Ingelheim, grants and personal fees from GSK, personal fees from Mundipharma, personal fees from Novartis, personal fees from TEVA, outside the submitted work. Dr. T.v.d.M. reports grants and personal fees from Glaxo, grants and personal fees from Astra Zeneca, personal fees and non-financial support from Teva, personal fees from Mundifarma, personal fees from Boehringer Ingelheim, outside the submitted work. Dr. J.F.M.v.B. reports grants (GSK, Boehringer Ingelheim), consultancy fees (AstraZeneca) and travel fees (European COPD Coalition, Respiratory Effectiveness Group) outside the submitted work. Other authors report no disclosures.

Figures

Fig. 1
Fig. 1
Flow diagram on article inclusion
Fig. 2
Fig. 2
Quality assessment of included studies. Percentages represent the percentage of included articles having a high risk (black bar), unclear risk (light grey bar) or low risk (medium-grey bar) of bias for each category in the Cochrane Collaboration’s risk of bias assessment tool
Fig. 3
Fig. 3
Improvement in inhaler technique plotted against baseline performance (a, b), type of intervention (c, d), and patients’ disease background (e, f) with 95% confidence intervals. The left column (a, c, and e) displays results for correct-steps studies, the right column shows results for correct-patients studies

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