A systematic review about the possible role of learning theories in the development of a new educational model for inhalation technique in patients with asthma or COPD

16 May 2023

Research Question from the IPCRG’s Research Prioritisation exercise: ‘’What are the best methods to teach about inhaler use and how to incorporate this in daily clinical practice?’

Background: Adequate inhaler technique is crucial to maximise the benefits of inhaled medication. Although the importance of teaching a correct inhaler technique has been recognised, yet, the optimal method of inhaler technique education is still unknown. Inhaler technique can be considered as a ‘closed motor skill’, hence applying motor learning principles could support the tailoring of inhaler technique education. With this in mind, the first aim of this systematic review is to summarise useful theories and models on closed motor skill acquisition. Secondly, this project aims to develop an education model for improving inhaler technique by applying the derived theoretical principles. 

Methods: A literature search will be conducted on the electronic databases Pubmed, PsycINFO, ERIC, CINAHL, including papers published any time up to April 2023. For inclusion in the review, studies should describe (1) a theoretical framework of motor learning involving adults; (2) consider a closed reproductive motor skill; (3) be written in English or Dutch. Studies will be excluded if they describe motor learning in patients with cognitive disabilities. Two reviewers will independently identify potentially relevant articles based on titles and abstracts. Full-text articles will be retrieved and checked independently for compliance with inclusion and exclusion criteria. Disagreements will be resolved by consensus or a third reviewer. The quality of evidence will be evaluated by a modified version of the Downs and Black checklist.

Questions to discuss: Do you think such a review will be useful for the setting you are working? Any additions to the search strategy? What would be the optimal timing of educational-interventions targeting inhaler technique errors, and is continuous monitoring needed for all patients? 

Resource information

Respiratory conditions
  • Asthma
  • COPD
Respiratory topics
  • Treatment - drug
Type of resource
Munich 2023
Lars Dijk 1,2, Kim Burger 2,3, Siebrig Schokker 4, Esther Metting 2,3, Paul Hagedoorn 2,5,6, Ellen Van Heijst 8, Titia Klemmeijer 4,6, Marion den Boer-Steurs 7, Miguel Román-Rodríguez 9, Ioanna Tsiligianni 10, Thys van der Molen 2,3, Janwillem Kocks 1,2,11,12 1 General Practitioners Research Institute (GPRI), Groningen, The Netherlands, 2 Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, 3 Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, 4 Research Institute, Martini Hospital, Groningen, the Netherlands, 5 Department of Pharmaceutical Technology and Biopharmacy, University of Groningen, Groningen, the Netherlands, 6 Inhalation Institute of the Netherlands (IIN), Groningen, the Netherlands, 7 Medical Center Hoogezand-Sappemeer, Hoogezand, the Netherlands, 8 Certe, integral medical diagnostic services and advice, Groningen, the Netherlands, 9 Primary Care Respiratory Research Unit. Instituto de Investigación Sanitaria de las Islas Baleares. IB-Salut, Palma de Mallorca, Spain, 10 Department of Social Medicine, Health Planning Unit, Faculty of Medicine, University of Crete, Rethymno, Greece, 11 Observational and Pragmatic Research Institute, Singapore, Singapore, 12 Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands