Interventions to improve inhaler technique for people with asthma

Normansell, Rebecca; Kew, Kayleigh M

doi:10.1002/14651858.cd012286

Cited by 29 publications

(44 citation statements)

References 41 publications

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“…Criteria used were broad, yielding a representative selection of studies. Previous systematic reviews 21,22 on the same topic were also screened for secondary sources of important studies, which minimizes the risk of bias in this process. During the selection process, in addition to RCTs, we included nonrandomized studies to avoid underestimation of true effects of inhaler education programs.…”

Section: Potential Biases In the Review Processmentioning

confidence: 99%

“…In addition, the main results of this analysis are similar to those reported in previous systematic reviews. 21,22 Performing a meta-analysis of such different and complex interventions could lead to false interpretation of results, because these studies are not truly comparable. To overcome this, we confirmed the main meta-analysis findings using trial sequential analysis (Supplementary Appendix S4), which strongly reinforced the finding of a significant reduction of exacerbations, increasing confidence in the results and excluding risk of a false-positive result.…”

Section: Potential Biases In the Review Processmentioning

confidence: 99%

“…This systematic review stands out from previous ones for several reasons. 21,22 First, it focuses on older adults, who often have poor clinical control, are more susceptible to exacerbations, and often have poor inhaler technique. 25,26 In addition, we included randomized and nonrandomized studies, which allowed us to make realistic conclusions about the effect of inhaler technique education.…”

Section: Comparison With Other Studies and Reviewsmentioning

confidence: 99%

“…In a systematic review, 21 the authors included only individuals with asthma and included adults and older adults together, without performing a subgroup analysis of the latter. This spread of age ranges may have introduced some bias, mainly derived from endotypic and phenotypic disease differences, which could lead to different clinical responses to education on inhaler performance.…”

Section: Comparison With Other Studies and Reviewsmentioning

confidence: 99%

“…One concluded that there is lack of evidence about which is the best education method to improve inhaler technique. 21 The other concluded that there is sufficient evidence of the efficacy of different inhaler educational strategies, but the authors did not quantify this effect with precision because it did not include a meta-analysis. 22 In addition, neither review focused on older adults.…”

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confidence: 99%

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Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta‐Analysis

Maricoto

Monteiro

Gama

et al. 2018

J American Geriatrics Society

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Objectives To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronic obstructive pulmonary disease (COPD). Design Systematic review and meta‐analysis. Setting and Participants Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting. Measurements We searched the Medline, Embase, and Central databases according to the main eligibility criteria for inclusion: systematic reviews, meta‐analysis, clinical trials and quasi‐experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random‐effect model with Mantel–Haenszel adjustment to perform a meta‐analysis. Results We included 8 studies (4 randomized, 4 quasi‐experimental) with a total of 1,812 participants. The most frequent type of intervention was physical demonstration of inhaler technique, training with placebo devices. Five studies showed significant reduction in exacerbation rates (pooled risk ratio=0.71, 95% confidence interval=0.59–0.86; p < .001), although effect on disease control and quality of life showed high discrepancy in the reported results, and all randomized studies revealed uncertainty in their risk of bias assessment. Conclusion All interventions seemed to improve inhaler performance and clinically relevant outcomes, but a placebo device could be the most effective. There is evidence that interventions reduce exacerbation risk in older adults, although to an overall moderate degree. J Am Geriatr Soc 67:57–66, 2019.

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Section: Potential Biases In the Review Processmentioning

confidence: 99%

Section: Potential Biases In the Review Processmentioning

confidence: 99%

Section: Comparison With Other Studies and Reviewsmentioning

confidence: 99%

Section: Comparison With Other Studies and Reviewsmentioning

confidence: 99%

mentioning

confidence: 99%

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Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta‐Analysis

Maricoto

Monteiro

Gama

et al. 2018

J American Geriatrics Society

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Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

et al. 2023

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ImportanceChildhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority.ObjectiveTo assess actual and perceived optimal childhood asthma monitoring practices used globally.Design, Setting, and ParticipantsThis international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies.Main Outcomes and MeasuresOutcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains.ResultsA total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest.Conclusions and RelevanceThese survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.

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