Evidence map›Paper›PMID 31342732›Full record

ReviewChronic obstructive pulmonary diseases (Miami, Fla.)2019

Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies.

Soojin Cho-Reyes, Bartolome R Celli, Carole Dembek, Karen Yeh, Maryam Navaie

Registry-linked trialOpen access · diamondAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Chronic obstructive pulmonary diseases (Miami, Fla.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06958666 (Effectiveness of DITM Versus IMT in COPD Patients With High Symptom Burden and High Risk of Acute Exacerbation), which is not on this map. Cited by 38 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 4 pooled it
6.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06958666 narecruitingnot on this mapstarted 2025, after this paper: background citation

Effectiveness of DITM Versus IMT in COPD Patients With High Symptom Burden and High Risk of Acute Exacerbation: A Randomized Controlled Study

TypeinterventionalSponsorSir Run Run Shaw HospitalRan2025 to 2028Enrolled410ConditionsCOPD (Chronic Obstructive Pulmonary Disease)ArmsDigital Inhaled Therapy Management, Inspiratory Muscle Training
3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 4 syntheses or guidelines pooled it, 80 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 1 country.

Soojin Cho-ReyesAdvance Health Solutions, LLC, New York, New York.
Bartolome R CelliHarvard Medical School, Boston, Massachusetts and Chronic Obstructive Pulmonary Disease Center, Brigham and Women's Hospital, Boston, Massachusetts.
Carole DembekGlobal Health Economics and Outcomes Research, Sunovion Pharmaceuticals, Inc., Marlborough, Massachusetts.
Karen YehAdvance Health Solutions, LLC, New York, New York.
Maryam NavaieAdvance Health Solutions, LLC, New York, New York.
Public Health Solutions · USColumbia University · USHarvard University · USVion Pharmaceuticals (United States) · US

Funding

Sunovion Pharmaceuticals Inc.
6 · The paper itself

Abstract

backgroundMetered dose inhalers (MDIs) are commonly prescribed for inhalation therapy, but correct use is critical to promoting effective medication delivery. This systematic literature review and meta-analysis evaluates the overall and step-by-step prevalence of errors among adults with obstructive lung diseases in the United States who used MDIs.

methodsElectronic and manual searches conducted between 1979-2018 using PubMed, EMBASE, PsycINFO, Cochrane, and Google identified 10 articles that met the following inclusion criteria: (a) English language, (b) U.S. adults diagnosed with chronic obstructive pulmonary disease, and (c) MDI use error rates. Meta-analytic techniques using random-effects models were applied to calculate effect sizes, weighted proportions, and 95% confidence intervals (CIs). Heterogeneity was assessed by the I

resultsAggregate findings revealed that 86.7% of patients (n=390, 95% CI 77.5-96.0) made at least 1 inhalation technique error, and 76.9% (n=885, 95% CI 65.8-87.9) incorrectly performed ≥ 20% of device use steps. The most prevalent step-by-step errors across the studies (n=1105) were failure to: (a) exhale fully and away from the inhaler before inhalation (65.5% [95% CI 52.0, 78.9]); (b) hold breath for 5-10 seconds (41.9% [95% CI 29.8, 53.9]); (c) inhale slowly and deeply (39.4% [95% CI 26.2, 52.5]); (d) exhale after inhalation (35.9% [95% CI 17.0, 54.8]); and (e) shake the inhaler before use (34.2% [95% CI 30.6, 37.7]).

conclusionsAcross the studies used in this meta-analysis more than three-fourths of U.S. adults with obstructive lung diseases used MDIs incorrectly. Our findings suggest the need for ongoing patient education and consideration of alternative devices to mitigate errors.

Indexed as

asthmachronic obstructive pulmonary diseasecopdhandheld inhalersinhalation techniqueinhaler educationinhaler errorsMDI errorsmeta-analysismetered-dose inhaler errorsnebulizerssystematic literature review

Identifiers

PMID31342732
PMCPMC6872219
OpenAlexW2963596000

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.