320 - Inhaler Technique in Children with Asthma: An Updated Systematic Review

Publication Number: 2309.320

Susan L. Flesher, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, United States; Jordan Ratcliffe, Marshall University Joan C. Edwards School of Medicine, Prichard, WV, United States; Jachua Polcyn, Medical College of Georgia at Augusta University, Augusta, GA, United States; Robert VanBrackle, Medical College of Georgia at Augusta University, Augusta, GA, United States; Marie Frazier, Marshall University, Huntington, WV, United States; Chris Gillette, Wake Forest University School of Medicine, Clemmons, NC, United States; Nicole Rockich-Winston, Medical College of Georgia at Augusta University, Augusta, GA, United States

Background: Asthma affects millions of children in the US. Past research has shown inhaler technique is poor which is associated with poor asthma control. Our previous systematic review in 2015 found that only about 1 in 10 children can use an inhaler properly, and that interventions can improve technique.

Objective: This systematic review sought to examine whether inhaler technique has improved over the last decade, updating our previous review's findings. We examined the prevalence of correct technique, evaluated the effectiveness of interventions, and examined the relationship between technique and asthma outcomes. Since our previous review used studies primarily from the Global North, we also sought to include more research data from countries in the Global South.

Design/Methods: The following databases were searched (Table 1): Global Index Medicus, Web of Science, PubMed, CINAHL Complete, and Embase. Studies were eligible if at least one of their outcome measures included and reported the results of inhaler technique in patients with asthma aged 6 - 18 years; and at least one key research question was addressed. Key questions were prevalence of correct inhaler technique, if educational interventions were associated with improved rates of correct technique, and if improved technique was associated with improved asthma outcomes. Covidence, a web-based software, was used to manage the data. Extracted data included country, setting, design, type of inhaler, how technique was measured, inclusion and exclusion criteria, type, frequency, and timing of intervention, and effect of the intervention.

Results: Seventy-three studies were eligible for inclusion (Table 2). The prevalence of correct inhaler technique varies widely (Table 3). Studies with the lowest prevalence of correct technique focused on populations characterized by low income, urban or inner-city environments, reliance on public insurance, and rural areas. Interventions included general education, counseling, and video-based interventions. There was a positive association between educational interventions and improved technique.

Conclusion(s): There is variability in prevalence of correct inhaler technique and technique continues to be poor. There is a positive association between educational interventions and rates of correct technique, which is associated with improved outcomes. What's New: This systematic review builds on the original review and includes research from the Global South to better understand the global prevalence of correct inhaler technique in children.

Table 1: Search Strategy
Shows the PubMed search strategy.

Table 2: Studies for Inclusion
Shows Each Study in the Review as Well as Study Characteristics

Table 3: Evidence Table
Depicts Findings of Each Study