Background:

Despite the plethora of inhaler devices developed to treat airway diseases, control remains poor worldwide with inadequate inhaler technique (IT) presented as one of the reasons for this. Scoring IT has been used within literature as an outcome measure of performance, but no such tool is currently used in clinical practice in the UK. This could be an invaluable tool for guiding inhaler technique observation & optimisation

Aim:

Undertake a systematic review identifying methods of scoring IT in literature

Methods:

The protocol was registered with PROSPERO and a comprehensive database search carried out. Articles were systematically reviewed by 2 reviewers in accordance with PRISMA standards & methods of scoring IT tabulated

Results:

·77 articles use a score to assess IT performance

·6 groups of scoring IT identified:

-54/77 (70%) awarded 1 point per step in the checklist

-7/77 (9%) graded the final score

-7/77 (9%) expressed the total score as a percentage or ratio

-3/77 (4%) weighted steps in the checklist

-2/77 (3%) deducted points from the final score 

-4/77 (5%) undertook robust validation processes required in instrument validation

·18 different device types were identified MDIs the most common & included in 51/77 (66%) of articles

·Vast heterogeneity in the number of steps & disparate content in the inhaler technique checklists across all device types (range 5-19 steps)

·28/77 (36%)articles did not reference the origin of the checklist used in their study

Conclusion:

This SR ascertains that IT is frequently assessed with a score as an outcome measure in literature, but scoring methods are arbitrary,disparate and lack validation.It also highlights the need for a validated tool for use in clinical practice to aid IT optimisation