. Author manuscript; available in PMC: 2021 Jul 1.

Published in final edited form as: J Allergy Clin Immunol Pract. 2020 Mar 12;8(7):2234–2242. doi: 10.1016/j.jaip.2020.03.003

Table 5.

Studies evaluating critical inhaler steps for DPIs as defined by lung deposition or disease control

Inhaler step	Affects drug delivery	Affects symptoms or disease control

Expose mouthpiece/remove cap		Price (2017)⁵⁶

Cock the trigger or twists base (prepares medication)	Meakin (1995)¹⁰³

Inhaler is not tilted, tipped, or shaken after preparing dose		Price (2017)⁵⁶

Head tilted so that chin is slightly upward

Seal lips around mouthpiece		Price (2017)⁵⁶

Hold inhaler horizontally while inhaling	Kondo (2017)¹⁰⁴

Exhale before inhalation

Does not exhale into device	Meakin (1995)¹⁰³
	Holmes (2015)¹⁰⁵
	Sulaiman (2017)¹⁰⁶

Hold inhaler horizontally while inhaling

Inhale quickly and deeply	Pedersen (1986)¹⁰⁷	Price (2017)⁵⁶
	Pederson (1990)¹⁰⁸
	Engel (1992)¹⁰⁹
	Newman (1991)¹¹⁰
	Borgström (1994)¹¹¹
	Pitcairn (1994)¹¹²
	Palander (2000)¹¹³
	Sulaiman (2017)¹⁰⁶
	Olsson (1996)¹¹⁴

Hold breath for 6–10 seconds	Horváth (2017)¹¹⁵

Replace cap/click shut