title: Inhaler Technique in Children With Asthma: A Systematic Review.
abstract: Pediatric asthma is an important public health problem worldwide. The primary methods of medication delivery are inhalation devices.
  
  
  
  This systematic review examined: 1) what is the prevalence of correct inhaler technique among children with asthma, 2) are educational interventions associated with improved rates of correct inhalation technique, and 3) is improved inhaler technique associated with improved asthma outcomes?
  
  
  
  We included experimental and observational studies through searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, and clinicaltrials.gov.
  
  
  
  Studies were eligible for this review if at least 1 outcome measure of the study included and reported results of child/adolescent inhaler technique.
  
  
  
  The following information was extracted from each included study: study design (experimental vs observational), and outcomes data. The Downs and Black checklist was used to appraise study quality.
  
  
  
  Twenty-eight studies were eligible for inclusion. We found that inhaler technique is generally very poor among children, but is better when children use their metered-dose inhalers (MDIs) with spacers. Technique in using turbuhalers and diskus inhalers is better than in MDI, but still poor. Counseling children on correct inhaler technique was associated with improved technique among children in multiple studies.
  
  
  
  We examined articles published in English.
  
  
  
  Inhaler technique in children is generally poor. Physicians and other members of the health care team should instruct children and their caregivers on the proper use of their inhalation devices at every opportunity and correct mistakes when made to ensure effective medication delivery.
  
  
  
  This systematic review was registered under the Centre for Reviews and Dissemination, PROSPERO CRD42015025070 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025070).
authors.affiliation: Marshall University School of Pharmacy, Huntington, WVa; Marshall University College of Health Professions, Huntington, WVa. Electronic address: gillettec@marshall.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Gillette
authors.affiliation: Marshall University School of Pharmacy, Huntington, WVa.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rockich-Winston
authors.affiliation: Marshall University School of Pharmacy, Huntington, WVa.
authors.forename: JoBeth A
authors.initials: JA
authors.lastname: Kuhn
authors.affiliation: Marshall University Joan C. Edwards School of Medicine, Huntington, WVa.
authors.forename: Susan
authors.initials: S
authors.lastname: Flesher
authors.affiliation: Marshall University Joan C. Edwards School of Medicine, Huntington, WVa.
authors.forename: Meagan
authors.initials: M
authors.lastname: Shepherd
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D006801:Humans; D036503:Inhalation Spacers; D036501:Metered Dose Inhalers; D009330:Nebulizers and Vaporizers
chemical_list: D001993:Bronchodilator Agents
keywords: adolescent; asthma; bronchodilator agents; child; dry powder inhalers; inhalation spacers; metered-dose inhalers