Interventions Evaluated to Improve Inhaler Adherence in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review.

Background: Inhalation therapy is central for chronic obstructive pulmonary disease (COPD) management. However, poor inhaler adherence is associated with increased mortality, decreased quality of life, and increased costs. Existing interventions, particularly their design and delivery across urban and rural settings, have not been comprehensively mapped. Objective: To map the available interventions evaluated to improve inhaler adherence among patients with COPD and characterize their components, delivery approaches, reported outcomes, and variation across urban and rural settings. Methods: Following the Arksey and O'Malley framework, nine databases were searched from inception to March 22, 2026, including PubMed, Cochrane Library, Embase, Medline, Web of Science, CNKI, WanFang Data, CBM, and CQVIP. Two researchers independently screened the literature, extracted data, and synthesized findings. Results: The 24 included studies were from seven countries (19 randomized controlled trials, 2 quasi-experimental studies, 1 prospective cohort study, and 2 pre-post studies); 16 were published in Chinese and 8 in English. Six categories were identified according to the primary intervention component: education-focused (n=8), behaviour-focused (n=4), inhaler technique-focused (n=4), multicomponent (n=3), transitional care-focused (n=4), and reminder-focused interventions (n=1). Five studies used digital delivery, including videoconferencing, telemedicine, SMS, a gamified website, and a WeChat mini-program. Most studies reported improved inhaler adherence, while one found no statistically significant difference. Twenty-two studies were conducted in urban settings; only two Chinese studies targeted rural populations, both used transitional care with face-to-face education, telephone follow-up, and family involvement. Conclusion: The combined evidence suggests that interventions were diverse and predominantly in urban settings. Theory-informed design, ongoing follow-up, technique reassessment, digital support, and caregiver involvement were frequently identified across interventions reporting improved adherence. However, heterogeneity in intervention characteristics and adherence measures limited comparability, while evidence from rural populations remained scarce. Future research should consider longer follow-up and digital technologies to deliver personalized, sustainable interventions, particularly in rural settings.