Table 1 Designs of identified studies in asthma and COPD reporting associations between device errors and clinical outcomes

From: Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD

References Study type Country Setting Patient age Sample size, n Inhaler(s) studied Outcomes studied Device error definition
Asthma only
 Giraud & Roche 200222 Clinical cross-sectional France OP  > 15 years 4078 pMDI Clinical, economic Misusers vs. good users ( ≥ 1 vs. no errors), and poor coordinators vs. good coordinators ( ≥ 1 vs. no errors between actuation and inhalation)
 Molimard & Le Gros 200823 Clinical cross-sectional France OP Adults 4362 pMDIs, DPIs Clinical Patients making ≥ 1 critical errors vs. patients using inhaler correctly
 Giraud, Allaert & Magnan 201124 Clinical cross-sectional France OP Adults 6512 Breath-actuated MDI Clinical Patients with suboptimal vs. optimal technique (optimal = correctly following 7-step checklist and avoiding five possible errors)
 Natsir et al. 201325 Clinical cross-sectional Indonesia OP Adults 60 NR Clinical, economic Patients demonstrating improper inhaler use, evaluated using a checklist based on Global Initiative for Asthma
 Al-Jahdali et al. 201326 Clinical cross-sectional Saudi Arabia ED Adults 450 MDIs, DPIs Clinical, economic Proper vs. improper inhaler use (proper use = fulfilled all required steps on a device checklist over two trials of using their inhaler)
 Baddar, Jayakrishnan & Al-Rawas 201427 Clinical cross-sectional Oman OP 12−72 years 218 NR Clinical Good inhaler technique (all essential steps performed accurately) vs. poor inhaler technique (any required steps missed/performed inaccurately)
 de Tarso Roth Dalcin et al. 201428 Clinical cross-sectional Brazil OP Adults 268 MDIs, DPIs Clinical Correct ( < 2 errors) vs. incorrect inhaler technique ( ≥ 2 errors)
 Giraud, Allaert & Roche 201129 Prospective clinical (1 month follow-up) France Pharmacy Adults 727 pMDIs, breath-actuated MDIs Clinical Optimal use (no errors) vs. non-optimal use ( ≥ 1 critical or non-critical error)
 Yildiz et al. 201430 Prospective clinical, longitudinal ( ≥ 6 months follow-up) Turkey OP Adults 572 pMDIs, DPIs Clinical Patients making 0–1 basic errors vs. patients making > 1 basic error
 Harnett et al. 201431 Prospective clinical, longitudinal (3−4 months follow-up) Ireland OP  ≥ 16 years 40 pMDIs, DPIs, soft-mist inhaler Clinical, QoL Optimal users (no errors) vs. misusers ( ≥ 1 of 10 steps performed incorrectly)
 Levy et al. 201332 Retrospective, database (IMPACT), cross-sectional UK All ages 3981 MDIs, DPIs Clinical Patients with correct vs. incorrect technique (incorrect technique = failure of one or more of: inspiratory flow between 10–50 L/min; correct flow for ≥ 1.5 s post-actuation; post-inspiration breath hold for ≥ 5 s)
 Price et al. 201719 Retrospective, database (iHARP), cross-sectional Australia, Europe  ≥ 16 years 3660 pMDIs and DPIs Clinical Frequency of specific errors and device-specific errors
COPD only
 Molimard et al. 201733 Clinical cross-sectional France OP  > 40 years 2935 pMDIs, Respimat, DPIs Clinical, economic Patients with absence of error vs. presence of critical error
Both asthma and COPD
 Melani et al. 20118 Clinical cross-sectional Italy OP  > 14 years 1664 MDIs, DPIs Clinical, economic Inhaler misuse (patients with presence of error or critical error)
 Maricoto et al. 201534 Clinical cross-sectional Portugal OP  > 12 years 62 MDIs, DPIs Clinical Patients with ≥ 1 error, number of errors committed (0–4)
 Roggeri, Micheletto & Roggeri 201635 Clinical cross-sectional Italy OP  > 14 years 400 NR Economic See above (Melani et al. 2011)8
  1. COPD chronic obstructive pulmonary disease, DPI dry-powder inhaler, ED emergency department, iHARP Improving Health of At-Risk Rural Patients, IMPACT InforMing the PAthway of COPD Treatment, MDI metered-dose inhaler, NR not reported, OP outpatient, pMDI pressurised metered-dose inhaler, QoL quality of life