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Meta-Analysis
. 2025 Mar 18;35(1):15.
doi: 10.1038/s41533-025-00422-0.

Inhalation technique-related errors after education among asthma and COPD patients using different types of inhalers - systematic review and meta-analysis

Monika Marko  1 , Rafał Pawliczak  2
Affiliations
Meta-Analysis

Inhalation technique-related errors after education among asthma and COPD patients using different types of inhalers - systematic review and meta-analysis

Monika Marko et al. NPJ Prim Care Respir Med. .

Abstract

In asthma and chronic obstructive pulmonary disease (COPD) incorrect use of inhalers is still common. The aim of the study was to detect whether education improves inhalation skills and whether the type of education influenced the educational effect depending on the device. A systematic review and meta-analysis for errors during inhalation before and after education was performed. The selected data allowed for education assessment of dry powder (DPIs) and pressurised metered dose (pMDI/MDIs) inhalers in a meta-analysis. Education reduced critical errors (risk ratio [RR], 0.28, 95% confidence interval [CI]: 0.17, 0.47, P < 0.00001) and any incorrect use events for DPI (RR = 0.38, 95% CI: 0.21, 0.70, P = 0.002) and pMDI/MDIs, (RR = 0.16, 95% CI: 0.11, 0.23, P < 0.00001). Education improves patient's inhalation skills regardless of the device. The educational effect for pMDI/MDIs depends on the type of educational approach which has not been demonstrated for DPIs.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the screening procedure.
Fig. 2
Fig. 2. Risk of bias assessment.
a Risk of bias summary: review authors’ judgements about each risk of bias item for each included study. b Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Fig. 3
Fig. 3. Risk ratio for critical errors in patients using DPI inhalers before and after education in form of demonstration.
DPI dry powder inhaler, COPD Chronic obstructive pulmonary disease.
Fig. 4
Fig. 4. Risk ratio for any incorrect use events in patients using DPI inhalers before and after education based on the educational approach type.
DPI dry powder inhaler, BI brief intervention, TTG teach-to-goal.
Fig. 5
Fig. 5. Risk ratio for any incorrect use events in patients using pMDI/MDI inhalers before and after education based on the educational approach type.
Data from the pMDI/MDI studies in the meta-analysis did not include the use of a spacer. pMDI: pressurized metered dose inhaler.
See this image and copyright information in PMC

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