Inhaler Technique in Children With Asthma: A Systematic Review

Introduction: Asthma is a disease affecting millions of pediatric patients worldwide and past research has shown a correlation between incorrect inhaler technique and suboptimal asthmatic control. The key study questions in this review assessed the prevalence of correct inhaler technique, the effectiveness of educational interventions concerning improved asthma technique, and the relationship between improved inhaler technique and asthma outcomes.


Methods: In this systematic review, study screening and data extraction were performed using Covidence according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were eligible for inclusion if they included at least one outcome measure reported on inhaler technique among patients age 6-18 years old, and at least one of key study question was addressed. If both adult and pediatric results were reported, only studies that stratified the data by age were included. The following information was extracted from each study: study design (experimental vs observational), type of device being assessed, modality of assessing correct technique, inclusion and exclusion criteria, number of participants, and outcomes data.


Results: The prevalence of reported correct inhaler technique in children varied widely across studies. There were positive correlations between educational interventions and correct inhalation technique, with video training having comparable results to in person trainings. There were also positive associations between improved inhaler technique and asthma outcomes including quality of life and hospitalizations for exacerbations.


Conclusions: There is variability in correct pediatric inhaler technique, likely due to differences between each studies measurement cutoff points. Overall, pediatric inhaler technique is generally poor. There is a positive association between educational interventions and rates of correct inhaler technique, which is associated with improved outcomes. These improved outcomes include reduced exacerbations and inpatient hospitalizations. Patients and the family of patients with asthma should be consistently instructed on correct inhaler technique at every opportunity, with corrections being made to ensure effective medication delivery.