Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; University of Portsmouth, School of Sport, Health and Exercise Science, UK; Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, UK.
Portsmouth Technology Trials Unit, Portsmouth Hospitals University NHS Trust, UK; University of Portsmouth, UK; Department of Respiratory Medicine, Portsmouth Hospitals University NHS Trust, UK.
Respir Med. 2023 Nov-Dec;219:107430. doi: 10.1016/j.rmed.2023.107430. Epub 2023 Oct 27.
Many inhaler devices are currently used in clinical practice to deliver medication, with each inhaler device offering different benefits to overcome technique issues. Inhaler technique remains poor, contributing to reduced airway drug deposition and consequently poor disease control. Scoring inhaler technique has been used within research as an outcome measure of inhaler technique assessment, and this systematic review collates and evaluates these scoring methods. The review protocol was prospectively registered in PROSPERO (CRD42020218869). A total of 172 articles were screened with 77 included, and the results presented using narrative synthesis due to the heterogeneity of the study design and data. The most frequently used scoring method awarded one point per step in the inhaler technique checklist and was included in 59/77 (77%) of articles; however limited and varied guidance was provided for score interpretation. Other inhaler technique scoring methods included grading the final inhaler technique score, expressing the total score as a percentage/ratio, deducting points from the final score when errors were made, and weighting steps within the checklist depending on how crucial the step was. Vast heterogeneity in the number of steps and content in the inhaler technique checklists was observed across all device types (range 5-19 steps). Only 4/77 (5%) of the inhaler technique measures had undertaken fundamental steps required in the scale development process for use in real world practice. This review demonstrates the demand for a tool that measures inhaler technique and highlights the current unmet need for one that has undergone validation.
目前临床上有许多吸入器设备用于输送药物，每种吸入器设备都有不同的优势，可以克服技术问题。但吸入器技术仍然很差，导致气道药物沉积减少，进而影响疾病控制。吸入器技术评分已在研究中被用作吸入器技术评估的结果衡量标准，本系统评价对这些评分方法进行了收集和评估。该综述方案已在 PROSPERO（CRD42020218869）中进行了前瞻性注册。共筛选出 172 篇文章，其中 77 篇被纳入，由于研究设计和数据的异质性，结果采用叙述性综合进行呈现。最常用的评分方法是在吸入器技术检查表中的每个步骤中给予 1 分，在纳入的 77 篇文章中有 59 篇（77%）使用了该方法；但对于评分解释，仅提供了有限且不同的指导。其他吸入器技术评分方法包括对最终吸入器技术评分进行分级、将总得分表示为百分比/比值、在出现错误时从最终得分中扣除分数，以及根据步骤的重要性在检查表中对步骤进行加权。观察到所有设备类型的吸入器技术检查表中的步骤数量和内容都存在很大的异质性（范围为 5-19 步）。在纳入的 77 篇文章中，仅有 4 篇（5%）的吸入器技术测量措施已经完成了在现实实践中使用所需的量表开发过程中的基本步骤。本综述表明需要一种能够测量吸入器技术的工具，并强调了目前对经过验证的工具的需求尚未得到满足。
