Published: 2019-05-24

Role of educational intervention with practical demonstration in improving inhaler technique

Bharat Bhushan, Kulbir Singh, Jebin Abraham, Deepak Goyal, Arjun Bhatnager, Jain Thomas Chungath, Heena Bharti, Karan Sharma


Background: Chronic respiratory diseases are among the leading causes of morbidity and mortality worldwide with chronic obstructive pulmonary disease (COPD) and asthma being the most common. There is under-utilization of the basic tools of inhalation therapy technique(s) in their management. Implementation of a personalized educational and demonstrational intervention by the attending physician during regular follow-up visits of these patients will substantially improve the treatment outcome.

Methods: This prospective interventional study was conducted on 239 diagnosed cases of asthma and COPD. Inhaler technique was assessed in accordance to standard checklist and errors were corrected by a practical demonstration. A follow-up assessment was conducted for the same after 2 weeks. Data thus collected was evaluated.

Results: Out of 239 patients, 47.6% (n=114) reported for follow-up assessment. Average reporting time for follow-up assessment was 27.4 days. Amongst them, an improvement of at least one step was found in 86.8% (n= 99) and about 28% (n=32) patients performed all steps correctly. Average number of steps improved was 2.1.

Conclusions: Majority of the patients showed an improvement in the inhaler technique during follow-up assessment after an educational intervention and practical demonstration. Near perfection was achieved by about more than quarter of the patients. Regular practical demonstration of the inhalation technique during subsequent follow-up sessions unequivocally improves results.


Asthma, COPD, Education, Inhaler technique, Practical demonstration

Full Text:



van Beerendonk I, Mesters I, Mudde AN, Tan TD. Assessment of the inhalation technique in outpatients with asthma or chronic obstructive pulmonary disease using a metered dose inhaler or dry powder device. J Asthma.1998;35:273-9.

Molimard M, Raherison C, Lignot S, Depont F, Abouelfath A, Moore N. Assessment of handling of inhaler devices in real life: an observational study in 3811 patients in primary care. J Aerosol Med. 2003 Sep 1;16(3):249-54.

Khassawneh BY, Al-Ali MK, Alzoubi KH, Batarseh MZ, Al-Safi SA, Sharara AM, et al. Handling of inhaler devices in actual pulmonary practice: metered-dose inhaler versus dry powder inhalers. Respir Care. 2008;53:324-28.

Rootmensen G, Van Keimpema AR, Jansen HM, De Haan RJ. Predictors of incorrect inhalation technique in patients with asthma or COPD. Am J Respir Crit Care Med. 2010;181:A3812.

Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105:930-8.

Dalcin PTR, Grutcki DM, Laporte PP, de Lima PB, Menegotto SM, Pereira RP. Factors related to the incorrect use of inhalers by asthma patients. J Bras Pneumol. 2014;40:13-20.

Capanoglu M, Dibek Misirlioglu E, Toyran M, Civelek E, Kocabas CN. Evaluation of inhaler technique, adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers. J Asthma. 2015;52:838-45.

Westerik JA, Carter V, Chrystyn H, Burden A, Thompson SL, Ryan D, et al. Characteristics of patients making serious inhaler errors with a dry powder inhaler and association with asthma-related events in a primary care setting. J Asthma. 2016;53:321-9.

Camilleri K, Balzan M, Bardon MP, Schembri E, Sullivan M, Mifsud S et al. Predictors of good inhaler technique in asthma and COPD. Eur Respir J. 2015;46:A-P3928.

Sadowski C, Banh H, Cor K, Cave A. Inhaler device technique in community dwelling older adults. Canadian J Hosp Pharm. 2013;66(4):269.

Basheti IA, Reddel HK, Armour CL, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol. 2007 Jun;119(6):1537-8.

Rubin BK and Fink JB. Optimizing aerosol delivery by pressurized metered-dose inhalers. Respir Care. 2005;50:1191-200.

Newman SP. Inhaler treatment options in COPD. Eur Respir Rev. 2005;14:102-8.

Sanchis J, Gich I, Pedersen S. Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? Chest. 2016;150(2):394-406.

Fernandes L, Mesquita A. Improving asthma control with therapeutic education intervention. Eur Respir J. 2011;38(55):4997.

Dąbrowska M, Łuczak K, Miszczuk M, Domagała I, Lubański W, Leszczyński A, et al. Impact of short training of inhalation technique on the course of asthma and COPD. Eur Respir J. 2017;50(61):536.