Identification of Parameters Associated With Asthma Inhaler Technique Errors

woman using asthma inhaler
Woman using an inhaler for asthma
A set of demographic and clinical parameters may be associated with inhaler technique error and worsening asthma outcomes.

A set of demographic and clinical parameters may be associated with inhaler technique error and worsening asthma outcomes, according to a study published in the Journal of Asthma.

In the cross-sectional study, the data of 4134 patients with asthma from the International Helping Asthma in Real life Patients database were examined. Patients were eligible if they had received a prescription for a fixed-dose combination inhaled corticosteroid and long-acting beta 2 agonist therapy and received ≥2 prescriptions in the year preceding the study. Patients used an accuhaler (n=82), turbuhaler (n=2065), or metered dose inhaler (n=1245).

Patients were asked to complete questionnaires to collect information on demographic and clinical characteristics, (ie, asthma control status and self-assessed inhaler technique). A Likert scale was used to assess inhaler technique, (score: from 1, very poor technique to 6, excellent technique). The 4 Global Initiative for Asthma criteria were used to assess asthma control and data on self-reported adherence to medication were collected.

Of patients using a turbuhaler device, 1248 reported ≥1 inhaler technique error. Patients reporting ≥1 inhaler technique error and worsening asthma outcomes were more likely to be women vs men (odds ratio [OR], 1.467; 95% CI, 1.201-1.793; P <.001) and to have a very poor to average vs good to excellent self-assessment of inhaler technique (OR, 1.607; 95% CI, 1.237-2.086; P <.001).

Of the 713 patients using a metered dose inhaler, 57.3% reported ≥1 inhaler technique error which were associated with poor asthma outcomes. Poor outcomes associated with technique error were more likely in women vs men (OR, 1.574; 95% CI, 1.131-2.191; P <.05), in individuals with a secondary education vs university degree (OR, 1.427; 95% CI, 1.026-1.984; P <.001), and in current vs non-smokers (OR, 1.587; 95% CI, 1.035-2.436; P <.005).

Of the patients using an accuhaler device, 51.6% reported making 1 to 4 errors, which were associated with poor asthma control. These patients had greater odds of not having their inhaler technique reviewed by a trained healthcare professional in the preceding 12 months (OR, 1.654; 95% CI, 1.225-2.235; P =.001) and of having very poor to average vs excellent self-assessment of inhaler technique (OR, 1.500; 95% CI, 0.468-0.950; P =.025).

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Limitations of the study include the lack of objective measures to assess inhaler technique and the sole inclusion of patients with a prescription for a single type of inhaler.

 “This study indicates that inhaler technique errors associated with poor asthma outcomes differ according to particular patient characteristics. These patient characteristics should be used to predict those patients who are likely to experience poorer asthma outcomes, as a result of poor inhaler technique and should be used to guide more appropriate prescribing of inhaler devices,” concluded the study authors.

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, Price DB, Bosnic-Anticevich S. Identifying patients at risk of poor asthma outcomes associated with making inhaler technique errors [published online March 31, 2020]. J Asthma. doi: 10.1080/02770903.2020.1742353