Impact of a Single Session of Inhalation Technique Training on Inhalation Skills and the Course of Asthma and COPD

Respir Care. 2019 Oct;64(10):1250-1260. doi: 10.4187/respcare.06740. Epub 2019 Jun 18.


Background: A significant percentage of patients with asthma and COPD do not use their inhalers properly. The aim of this study was to evaluate the impact of a single session of inhalation technique training on the frequency of inhalation errors and the course of asthma and COPD.

Methods: This randomized controlled trial included adults who had been diagnosed with and treated for asthma or COPD with at least one inhaler use daily on a regular basis. All subjects were followed for 6 months, at which time their inhalation technique was assessed and an individual inhalation training (study group) or a sham procedure (control group) was applied. The number of mishandlings was calculated as the ratio of the number of errors to the number of inhalers used by an individual subject. The effect of training was evaluated after 3 months and again after 6 months.

Results: 50 subjects with asthma and 50 subjects with COPD were enrolled. Only 20% of subjects made no critical errors before the intervention. Subjects who were trained in the proper inhalation technique made fewer errors after 3 months (32 of 50 vs 20 of 50). The relative risk was 1.63 (95% CI 1.1-2.4, P = .01) and the number needed to treat was 3.9 (95% CI 2.2-15). Despite the improvement in the inhalation technique, we found no reduction in the number of asthma/COPD exacerbations, symptom severity, or the quality of life. After 3 consecutive months, the efficacy of the intervention decreased, and only 66% of the former responders maintained the lower ratio of errors per inhaler. After 6 months, there was no difference in the number of subjects with better inhalation technique between intervention (24 of 50) and control group (27 of 50) (P = .62).

Conclusions: Although a single inhalation training leads to a reduction in the number of errors made during inhalation, it does not influence the course of asthma and COPD. The positive effect of a single inhalation technique training is temporary. ( registration NCT02131454.).

Keywords: COPD; asthma; inhalation errors; inhalation technique; inhaler; training of inhalation technique.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Asthma / drug therapy*
  • Disease Progression
  • Female
  • Humans
  • Inhalation*
  • Male
  • Medication Adherence
  • Metered Dose Inhalers*
  • Middle Aged
  • Motor Skills
  • Patient Education as Topic* / methods
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Quality of Life
  • Severity of Illness Index
  • Symptom Assessment
  • Time Factors

Associated data