SOURCE: Sanchis J, et al. Systematic review of errors in inhaler use: Has patient technique improved over time? Chest 2016;150:394-406.

Despite various technical advances in inhaler devices, the skill with which patients actually use such devices has shown little improvement over four decades. Certainly, most clinicians have experienced or will experience suboptimal outcomes attributable to non-nefarious misuse of intended treatments.

Inhalation devices include metered dose inhalers (MDI), breath-activated MDIs, dry powder inhalers, and MDIs with inhalation chambers. Sanchis et al reported on data from patients in 144 publications about observed inhaler technique (n = 54,354). Although the steps for each device varies, errors in use (failure to place teeth/lips on mouthpiece, failing to fully exhale before inhalation, failure to breath-hold after medication inhalation, etc.) were the rule rather than the exception.

Only 31% of users exhibited correct inhaler technique, with an equal number demonstrating poor technique. The authors documented that skillfulness of technique has not improved over 40 years of observation. Obviously, something has to change in the process of educating patients about inhaler technique if clinicians expect different results in the future.