Recognizing and Tackling Inhaler Technique Decay in Asthma and Chronic Obstructive Pulmonary Disesase (COPD) Clinical Practice

A poor inhaler technique continues to represent a substantial barrier to effective asthma and chronic obstructive pulmonary disease management. It can result in perceived lack of treatment effectiveness even with apparent adherence to a prescribed regimen of inhaled maintenance therapies, potentially resulting in an unnecessary change or escalation of treatment. Many patients are not trained to inhaler mastery in real-world practice; furthermore, even where mastery is initially achieved, an ongoing assessment and education are seldom maintained. In this review, we present an overview of the evidence for deterioration of the inhaler technique over time after training, investigate the factors that contribute to this deterioration, and explore innovative approaches to addressing the problem. We also propose steps forward drawn from the literature and our clinical insights. & COPY; 2023 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). (J Allergy Clin Immunol Pract 2023;11:2355-64)

Automated summary

Poor inhaler technique is a significant barrier to effective management of asthma and chronic obstructive pulmonary disease (COPD). It can lead to a perceived lack of treatment effectiveness, even when patients adhere to prescribed inhaled maintenance therapies. Training and ongoing assessment are often lacking in real-world practice. This review examines the evidence for deterioration of inhaler technique over time, identifies contributing factors, and explores innovative approaches to addressing the problem.