Keywords
Inhaler use
Educational
Management
GOLD guidelines
Submitted : 2025-08-06
Accepted : 2025-08-21
Published : 2025-09-05
Abstract
Purpose: The aim was to synthesize quantitative and qualitative research that identified the most effective educational strategies for nurse-led inhaler technique (IT) education in Chronic Obstructive Pulmonary Disease (COPD) patients, as perceived by patients, healthcare providers, and nurses. Methods: A systematic literature search in Embase, PubMed, Cochrane Library, Web of Science, and CINAHL from 2018 to 30 June 2024 was conducted. In total, 327 articles were identified. The results of 14 studies that met the inclusion criteria were synthesized. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing findings on the effectiveness of different educational strategies. All investigations had assessed patient adherence to IT. Results: Data indicated that nurse-led IT teaching strategies are effective in promoting IT adherence and correctness in COPD patients utilizing the personalized Teach-Back method. However, studies in disease control and comparison of patient IT satisfaction and self-efficacy need further investigation. Conclusion: The results of this study may contribute to the understanding of the most effective educational strategies in nurse-led IT education for COPD patients. The synthesized findings can be used for the development of new educational interventions and assessment instruments for IT adherence.
References
World Health Organization, 2024, Chronic Obstructive Pulmonary Disease (COPD), viewed on May 25, 2025. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Boers E, Barrett M, Su JG et al, 2023, Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA Network Open, 6(12): e2346598. https://doi.org/10.1001/jamanetworkopen.2023.46598
De Miguel-Díez J, Fernández-Villar A, Doña Díaz E, et al., 2024, Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care. Journal of Clinical Medicine, 13(2): 303. https://doi.org/10.3390/jcm13020303
Cumpston M, Li T, Page MJ, et al., 2019, Updated Guidance for Trusted Systematic Reviews: A New Edition of the Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Database of Systematic Reviews, 10(10): ED000142. https://doi.org/10.1002/14651858.ED000142
Page MJ, McKenzie JE, Bossuyt PM, et al., 2021, The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ, 372: n71. https://doi.org/10.1136/bmj.n71
Lian X, Wang L, 2022, Boolean Logic Function Realized by Phase-Change Blade Type Random Access Memory. IEEE Transactions on Electron Devices, 69(4): 1849–1857.
Chigbu UE, Atiku SO, Du Plessis CC, 2023, The Science of Literature Reviews: Searching, Identifying, Selecting, and Synthesising. Publications, 11(1): 2.
Sterne JAC, Savović J, Page M, et al., 2019, RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials. BMJ, 366: l4898. https://doi.org/10.1136/bmj.l4898
Crocker TF, Lam N, Jordão M, et al., 2023, Risk-of-Bias Assessment Using Cochrane's Revised Tool for Randomized Trials (RoB 2) Was Useful but Challenging and Resource-Intensive: Observations from a Systematic Review. Journal of Clinical Epidemiology, 161: 39–45. https://doi.org/10.1016/j.jclinepi.2023.06.015
Monteiro C, Maricoto T, Prazeres F, et al., 2022, Determining Factors Associated with Inhaled Therapy Adherence on Asthma and COPD: A Systematic Review and Meta-Analysis of the Global Literature. Respiratory Medicine, 191: 106724. https://doi.org/10.1016/j.rmed.2021.106724
Minozzi S, Cinquini M, Gianola S, et al., 2020, The Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2) Showed Low Interrater Reliability and Challenges in Its Application. Journal of Clinical Epidemiology, 126: 37–44. https://doi.org/10.1016/j.jclinepi.2020.06.015
Press VG, Arora VM, Kelly CA, et al., 2020, Effectiveness of Virtual vs In-Person Inhaler Education for Hospitalized Patients With Obstructive Lung Disease: A Randomized Clinical Trial. JAMA Network Open, 3(1): e1918205. https://doi.org/10.1001/jamanetworkopen.2019.18205
Al-Kharouf MS, Abdeljalil MH, Obeidat NM, et al., 2023, Video-Based Teach-to-Goal Intervention on Inhaler Technique on Adults With Asthma and COPD: A Randomized Controlled Trial. PloS One, 18(6): e0286870. https://doi.org/10.1371/journal.pone.0286870
Efil S, Enç N, Ece T, 2020, Effect of Training Provided to Patients With Chronic Obstructive Pulmonary Disease on Drug Management. Japan Journal of Nursing Science, 17(3): e12333. https://doi.org/10.1111/jjns.12333
Barnestein FP, Vázquez GN, Martín-Montañez E, et al., 2022, The Clinical Relevance of Inhalation Technique in Chronic Obstructive Pulmonary Disease Patients. Medicina Clinica, 158(10): 472–475. https://doi.org/10.1016/j.medcli.2021.04.034
Vázquez GN, Leiva FJ, Cotta LVM, et al., 2023, Effectiveness of an Educational Intervention About Inhalation Technique in Healthcare Professionals in Primary Care: A Cluster Randomized Trial. Frontiers in Pharmacology, 14: 1266095. https://doi.org/10.3389/fphar.2023.1266095
Ansari S, Hosseinzadeh H, Dennis S, et al., 2020, Activating Primary Care COPD Patients With Multi-Morbidity Through Tailored Self-Management Support. NPJ Primary Care Respiratory Medicine, 30(1): 12. https://doi.org/10.1038/s41533-020-0171-5
Lindh A, Theander K, Arne M, et al., 2022, One Additional Educational Session in Inhaler Use to Patients With COPD in Primary Health Care – A Controlled Clinical Trial. Patient Education and Counseling, 105(9): 2969–2975. https://doi.org/10.1016/j.pec.2022.05.013
Luley MC, Loleit T, Knopf E, et al., 2020, Training Improves the Handling of Inhaler Devices and Reduces the Severity of Symptoms in Geriatric Patients Suffering From Chronic-Obstructive Pulmonary Disease. BMC Geriatrics, 20(1): 398. https://doi.org/10.1186/s12877-020-01804-4
Kim YM, Yu M, Moon HR, et al., 2020, Effects of a Tailored Inhaler Use Education Program for Chronic Obstructive Pulmonary Disease Patients. Patient Education and Counseling, 103(4): 717–723. https://doi.org/10.1016/j.pec.2020.02.005
Çiğdem E, Gamze M, Hanife Ö, 2022, Effect of Inhaler Training on Self-Care Agency and Self-Efficacy of COPD Patients: A Randomized Controlled Trial. Erciyes Medical Journal, 44(4): 367–374. https://doi.org/10.14744/etd.2021.64160
Hsiao YH, Tseng CM, Sheu CC, et al., 2022, Shared Decision-Making Facilitates Inhaler Choice in Patients With Newly-Diagnosed Chronic Obstructive Pulmonary Disease: A Multicenter Prospective Study. International Journal of Chronic Obstructive Pulmonary Disease, 17: 2067–2078. https://doi.org/10.2147/COPD.S376547
Achterbosch M, van de Hei SJ, Dierick BJH, et al., 2024, Usability and Feasibility of the Test of Adherence to Inhalers (TAI) Toolkit in Daily Clinical Practice: The BANANA Study. NPJ Primary Care Respiratory Medicine, 34(1): 13. https://doi.org/10.1038/s41533-024-00372-z
Visser CD, Antonisse LLM, Alleda FM, et al., 2024, Self-Management Support With the Respiratory Adherence Care Enhancer Instrument in Asthma and Chronic Obstructive Pulmonary Disease: An Implementation Trial. British Journal of Clinical Pharmacology, 90(5): 1344–1356. https://doi.org/10.1111/bcp.16025
Ahn JH, Chung JH, Shin KC, et al., 2020, The Effects of Repeated Inhaler Device Handling Education in COPD Patients: A Prospective Cohort Study. Scientific Reports, 10(1): 19676. https://doi.org/10.1038/s41598-020-76961-y
Duarte-de-Araújo A, Teixeira P, Hespanhol V, et al., 2019, COPD: Misuse of Inhaler Devices in Clinical Practice. International Journal of Chronic Obstructive Pulmonary Disease, 14: 1209–1217. https://doi.org/10.2147/COPD.S178040
Wu J, Meng W, Ma Y, et al., 2024, Errors and Adherence to Inhaled Medications in Chinese Adults With COPD. Journal of General Internal Medicine, 39(1): 69–76. https://doi.org/10.1007/s11606-023-08378-y
Wang C, Liu K, Sun X, et al., 2022, Effectiveness of Motivational Interviewing Among Patients With COPD: A Systematic Review With Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. Patient Education and Counseling, 105(11): 3174–3185.