Changing the Course of the Next 40 Years: Time to Address Rampant Inhaler Misuse Using System-Level Educational Solutions

To the Editor:

We want to commend Griffith and colleagues for their study demonstrating the negative consequences of poor inhaler technique (1). The New York Times has published multiple articles that highlight the high rates of inhaler misuse across diverse patient populations, settings, and respiratory conditions, including one this spring (2). In a systematic review of patient inhaler technique published in 2016, Sanchis and colleagues noted that “inhaler technique … has not improved over the past 40 years” (3). Many of us who are dedicated to solving the issue of poor inhaler technique have developed interventions that lead to immediate improvements in inhaler technique skills (4–6). Our research has even shown that more effective technique interventions can reduce acute-care use compared with less effective interventions (4). However, we have also found that skills wane after a single educational session (4). Robust data on the effect of multisession educational interventions on patient maintenance of inhaler skills and clinical outcomes are greatly needed. Unfortunately, patient education as an intervention is consistently downgraded by funders as lacking innovation and potential for impact. We hope that studies such as this one by Griffith and colleagues will pique funders’ interest in supporting multicenter comparative effectiveness and implementation research to evaluate the long-term impact of high-quality, evidence-based inhaler skill-training interventions. Without this support, we fear that another systematic review in 40 years will again state that patient inhaler technique has remained unchanged.