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NPJ Prim Care Respir Med. 2018 Nov 16;28(1):43. doi: 10.1038/s41533-018-0110-x.

Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD.

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General Practitioners Research Institute, Groningen, The Netherlands.
Inhalation Consultancy Ltd, Yeadon, UK.
Department of Research Methodology, Measurement, and Data Analysis, Faculty of Behavioural, Management and Social Sciences, and Department of Epidemiology, Medisch Spectrum Twente, University of Twente, Enschede, The Netherlands.
Primary Care and Population Sciences, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, Southampton, UK.
NIHR Wessex Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Southampton, UK.
GSK, Value Evidence & Outcomes, Brentford, UK.
GSK, Real World Evidence & Epidemiology, Uxbridge, UK.
GSK, Real World Evidence & Epidemiology, Collegeville, PA, USA.
Department of Pharmacology, University of Bordeaux, Bordeaux, France.


Inhaled medications are the cornerstone of treatment and management of asthma and COPD. However, inhaler device errors are common among patients and have been linked with reduced symptom control, an increased risk of exacerbations, and increased healthcare utilisation. These observations have prompted GINA (Global INitiative for Asthma) and GOLD (Global initiative for chronic Obstructive Lung Disease) to recommend regular assessment of inhaler technique in a bid to improve therapeutic outcomes. To better define the relationship between device errors and health outcomes (clinical outcomes, quality of life, and healthcare utilisation) in asthma and COPD, we conducted a systematic review of the literature, with a particular focus on the methods used to assess the relationship between device errors and outcomes. Sixteen studies were identified (12 in patients with asthma, one in patients with COPD, and three in both asthma and COPD) with varying study designs, endpoints, and patient populations. Most of the studies reported that inhalation errors were associated with worse disease outcomes in patients with asthma or COPD. Patients who had a reduction in errors over time had improved outcomes. These findings suggest that time invested by healthcare professionals is vital to improving inhalation technique in asthma and COPD patients to improve health outcomes.

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