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