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Jane Lindsay, BScPT, CRE
If you think that your patients have trouble with correct inhaler technique, you’re right. A review study, published in Chest in 2016, has concluded that “incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years, pointing to an urgent need for new approaches to education and drug delivery.” 
The authors state: “The most frequent metered-dose inhaler (MDI) errors were in coordination (45%; 95% CI, 41%-49%), speed and/or depth of inspiration (44%; 40%-47%), and no postinhalation breath-hold (46%; 42%-49%). Frequent dry powder inhalers (DPI) errors were incorrect preparation in 29% (26%-33%), no full expiration before inhalation in 46% (42%-50%), and no postinhalation breath-hold in 37% (33%-40%). The overall prevalence of correct technique was 31% (28%-35%); of acceptable, 41% (36%-47%); and of poor, 31% (27%-36%). There were no significant differences between the first and second 20-year periods of scrutiny.” 
While this doesn’t come a surprise to respiratory educators, it reinforces the need to review inhaler technique, and to provide effective education when errors are found.
A list of proper instructions for inhaler technique are an important part of your toolbox, whether your patient population is pediatric or adult, acute or chronic. The authors have provided a table outlining “Essential Inhalation Maneuver Steps” which is available in the open-access full text article (see links below).
The Lung Association – Ontario also provides patient-friendly information on inhalation techniques, and provides an array of educational videos for the different devices.
1. Sanchis, J., Gich, I., Pedersen, S. Systematic review of errors ininhaler use: Has patient technique improved over time? Chest. 2016;150(2):394-406. doi: 10.1016/j.chest.2016.03.041. [PubMed].