Closing the Inhaler Gap: A Comprehensive Review of Training Tools to Optimize Pressurized Metered-dose Inhalers Use in Asthma and Chronic Obstructive Pulmonary Disease

Background: Although pressurized metered-dose inhalers (pMDIs) represent a cornerstone therapy for asthma and chronic obstructive pulmonary disease (COPD), the incorrect technique of these devices weakens their therapeutic efficacy. This review comprehensively evaluated the various training devices developed to address this issue. Methods: We conducted a literature search from 2015 to 2025, investigating a range of pMDI training interventions. These included placebo inhalers, dedicated inspiratory flow trainers, coordination aids like Trainhaler and Flo-Tone, smart inhaler sensors, as well as educational tools such as video tutorials, mobile applications, printed checklists, and multi-component training kits. Results: Training tools can significantly improve pMDI technique by reducing critical errors and high inspiratory flow rates as well as by improving short-term illness measures such inhaler use ratings. However, the data on long-term clinical benefits is not sufficient. Cost-effectiveness varies from cheaper option such as basic placebo inhalers and printed materials to advanced sensors which need larger initial investments that could be justified by avoiding asthma or COPD exacerbations. Challenges like time constraints, the need for ongoing training and maintenance, and unequal access to technology were addressed along with proposed solutions. Conclusion: Using pMDI training devices could solve the inhaler misuse challenges. Including these training approaches into clinical practice may offer a sensible approach to improve patient inhaler technique and improved therapeutic outcomes. In order to improve the efficacy of these training instruments, continuous innovation in device design and conduction of more robust clinical studies are important.