Gillette et al published a systematic review regarding inhaler technique in children

Inhaler technique in children is poor

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The researchers included 28 studies and evaluated the prevalence of poor inhaler technique, effective educational interventions and the relation between inhaler technique and asthma control.  Inhaler technique in children is poor, although the range of children with correct inhaler technique varied between studies and devices (range 0%-97% correct). Education can improve technique regardless the setting (online or in a clinic) or instructor (nurse, pharmacist or physician). Health care providers rarely evaluate inhaler technique in children. Inhaler technique can be improved by explaining the child what an inhaler is, how it works and how to use it. Above that, inhaler technique should be regularly monitored. Including different health care professionals (e.g. nurses and pharmacists) will improve technique. There is little research on the relation of inhaler technique and asthma outcomes.

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