Education, Sex, and Smoking Status May Predict Inhaler Technique Errors in Asthma

Woman using a bronchodilator, inhaler
Woman using a bronchodilator, inahler
Female sex, education, smoking status, and self-assessment of inhaler technique may predict which patients with asthma are more likely to use their inhalers incorrectly.

Female sex, education, smoking status, and self-assessment of inhaler technique may predict which patients with asthma are more likely to use their inhalers incorrectly, according to study results published in the Journal of Asthma.

Prospectively collected data from primary care practices across the United Kingdom, Australia, and Europe that participated in the international Helping Asthma in Real life Patients (iHARP) database were included in this retrospective analysis. The iHARP included a questionnaire that assessed demographics, symptoms, lung function, and inhaler technique of patients with asthma (n=2065; mean age, 50 years).

Patients in this study had previously been prescribed a fixed-dose combination inhaled corticosteroid and long-acting β2 agonist therapy. Investigators assessed patients’ asthma control status with the 4 Global Initiative for Asthma (GINA) criteria as well as patients’ self- assessment of inhaler technique using a Likert scale. The outcome of interest was inhaler technique errors, specifically those associated with uncontrolled asthma and/or increased asthma exacerbations.

A total of 29.3% of patients made 1 inhaler technique error that was associated with poor asthma control. Overall, 60.4% made between 1 to 6 inhaler technique errors, including not exhaling slowly to empty the lungs (26.3%), not holding the device upright (19.6%), and not inhaling forcefully from the beginning of inhalation (18.8%).

Significant factors associated with making ≥1 inhaler technique error associated with poor clinical outcomes in patients who used the Turbuhaler included female sex (P <.001) and self-reports of very poor to average inhaler technique (P <.001).

Patients who used a metered dose inhaler and made ≥1 error associated with poor asthma control were significantly more likely to be female (P =.007), have secondary education (P =.035), and were current smokers (P =.034).

Additionally, factors associated with making ≥1 technique error in patients who used the Accuhaler included lack of inhaler technique review by a trained healthcare professional in the previous 12 months (P =.001) and very poor to average self-assessment of inhaler technique (P =.025).

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Limitations of the study were the inclusion of somewhat subjective assessment measures of inhaler technique as well as the inclusion of only patients who had been prescribed 1 inhaler device type.

The investigators of this study suggested the identified patient characteristics associated with poor inhaler technique could be used to “predict those patients who are likely to experience poorer asthma outcomes” and may “be used to guide more appropriate prescribing of inhaler devices.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Barbara SA, Kritikos V, Prince DB, Bosnic-Anticevich S. Identifying patients at risk of poor asthma outcomes specifically associated with inhaler technique [published online March 31, 2020]. J Asthma. doi:10.1080/02770903.2020.1742353