Table 2 Characteristics of studies included in systematic review and meta-analysis.

Ahn et al.⁵⁸

a prospective cohort study

DPI^a, pMDI^a, SMI^a

261

>40

COPD

Face to face training using the “teach-back” technique provided by the nurse

Aksu et al.³¹

Prospective study

pMDI/MDI, DPI^a

108

≥18;

asthma and/or COPD,

asthma COPD overlap syndrome

1. Assessment of inhaler technique (own inhaler device).

2. Training on the use of the device.

3. Inhaler technique assessment (after 3 months).

Al-Kharouf et al.¹⁰

A prospective, open label, randomized controlled trial

pMDI^a

Respimat^a

Turbohaler, Accuhaler, Breezhaler^a

103

45–62;

asthma and/or COPD

1. Inhaler technique assessment at baseline.

3. Participants received either a standard verbal TTG education or a video-based TTG education.

2. Inhaler technique assessment at follow-up (after 3 months).

Aydemir et al.²¹

a real life, cross-sectional study and no intervention

DPI

pMDI/MDI

342

15–84;

asthma and/or COPD

1) Assessment of inhaler technique (own inhaler device).

2) Face to face training sessions.

3) Assessment of inhaler technique immediately after the training.

Balamurugan et al.³²

open-label, prospective, comparativemulti- center study

pMDI,

Synchrobreathe^a

162 (COPD), 239

(asthma), 59 (inhaler-naive healthy volunteers^b)

Asthma: 5–80^c

COPD: 40–80;

asthma and/or COPD,

healthy volunteers^b

1) Assessment of inhaler technique (patient previously used pMDI with spacer and healthy volunteers read leaflet)

2) Patients were provided training on using the pMDI.

3) Assessment of inhaler technique.

4) All the participants read the patient information leaflet for Synchrobreathe

5) Assessment of inhaler technique.

6) Training on the use of the device.

7) On day 14 patients demonstrated inhalation technique without training.

8) Assessment of inhaler technique.

Brusselle et al.⁵⁷

multi-centre, single arm, non-interventional, phase IV study

pMDI^a

126

Mean age: 66.2

COPD

Patients were trained by an HCP in the correct use of inhaler device using the MyPuff® app and/or the correct use leaflets.

Chrystyn et al.³⁴

randomised, crossover, open-label study

Diskus^a

Pulmoject^a

Turbohaler^a

(empty devices)

277 in Pulmojet-Diskus and 44 in Pulmojet-Turbohaler

(naive to the study devices).

≥18;

asthma and/or COPD

1) Patients reading the patient information leaflet.

2) Patients performed inhalation.

3) Patients watched a training video if serious errors potentially affecting dose delivery were recorded.

4) Patients repeated the inhalations.

Kim et al.⁶

prospective clinical study

pMDI^a

62

(patients

who were regularly using pMDI with or without spacers).

≥18 years and ≤90;

COPD

1) Rapid cognitive screen.

2) Inhaler technique assessment.

3) An active one-on-one coaching was provided (based on 12-step American Thoracic Society instructions).

4) Inhaler technique assessment and scored again at follow-up visits.

Nitya et al.¹⁷

a prospective cross-sectional study

pMDI

DPI

pMDI with spacer^a

144

>18;

asthma and/or COPD

1. Assessment of inhaler technique.

2. A face to face training session.

3. Assessment of inhaler technique on the next day after training.

Press et al.⁸

Phase-II, block randomized, stratified clinical trial

pMDI/MDI^a,

DPI

50

≥18;

asthma and/or COPD

1. Baseline inhaler assessment.

2. BI: single-set of verbal and written step-by-step instructions, -to-goal or TTG: BI plus repeated demonstrations of inhaler use and participant comprehension assessments (teach-back).

3. Post education assessment.

Press et al.⁷

two-site, block-stratified randomized clinical trial

Diskus and

pMDI with spacer^a

120

≥18;

asthma and/or COPD

1) Assessment of inhaler technique (pre-education).

2) Participants were randomized to TTG or brief intervention.

3) Assessment of inhaler technique.

Van der Palen et al.³³

randomised, cross-over study

Elpenhaler

and Diskus

(devices containing only placebo)

52 men and 61 women (naive to Diskus and Elpenhaler for at least 1 year)

≥40;

asthma and/or COPD

1) Patients read the instructions of device and attempted to first inhalation.

2) Assessment of errors.

3) When mistakes were made, correct inhaler use was demonstrated.

3) Patients had to demonstrate again, and mistakes were registered (the procedure was repeated 4 times).