Repeated counseling with pMDI devices reduced inhalation errors in adult asthma patients compared to pMDI alone

Photo by CDC / Unsplash

The Journal of asthma : official journal of the Association for the Care of Asthma Published May 1, 2026 Medically reviewed May 8, 2026 Study authors: Sobh Ahmed H M, Mohamed Basma M E, Ahmed Sayed Omar, Harb Hadeer Safwat, Abdelrahim Mohamed E A, Moh… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider adding MDI PLUS or AeroChamber2go to pMDI counseling to reduce initial inhalation errors in adults.

This prospective randomized clinical trial evaluated 300 adult asthma patients across three monthly separate visits. The study compared repeated counseling on inhalation technique using pMDI alone against pMDI plus MDI PLUS or pMDI plus AeroChamber2go. The primary outcome measured the number of technical errors in inhalation technique.

At the first visit, the MDI PLUS and AeroChamber2go groups made significantly fewer errors than the pMDI alone group, with p-values of 0.04 and 0.041 respectively. Error rates in the pMDI alone group decreased significantly by the third visit (p = 0.04). When comparing the two spacer devices, MDI PLUS consistently showed fewer errors than AeroChamber2go, though this difference was not statistically significant (p > 0.05).

Both spacer groups experienced significant, visit-to-visit improvements in FEV% of predicted, PEF% of predicted, and Asthma Control Test scores (all p < 0.05 between visit 1 and 2 and between visit 2 and 3). The pMDI alone group showed no significant change between visits 1 and 2, with statistically significant improvement only by visit 3 (FEV p = 0.04; PEF p = 0.03; ACT p = 0.04). Safety data, adverse events, and discontinuations were not reported.

Study Details

Study typeRct

EvidenceLevel 2

PublishedMay 2026

PMID41548248

View Original Abstract ↓

OBJECTIVE: This study aimed to measure the impact of repeated counseling on asthma control and inhaler technique using pressurized metered-dose inhaler (pMDI) alone and in combination with pMDI PLUS (cardboard-based spacer) or AeroChamber2go in adult asthma patients. METHODS: This is a prospective randomized clinical trial in which a cohort of 300 asthma patients was randomly allocated into three equal groups ( = 100): (1) pMDI alone, (2) pMDI + MDI PLUS, and (3) pMDI + AeroChamber2go. The patient groups were interviewed to assess the inhalation technique of the three devices, in parallel, upon three monthly separate visits. At baseline and during two subsequent monthly visits, each group received three standardized training sessions. Before each session, patients performed the inhalation steps with their assigned device, and the number of technical errors was recorded. Lung function (Forced Expiratory Volume in one second (FEV) % of predicted, Peak Expiratory Flow (PEF) % of predicted) and Asthma Control Test (ACT) scores were also assessed. RESULTS: At the first visit, MDI PLUS and AeroChamber2go groups made significantly fewer inhalation errors than the pMDI alone group ( = 0.04 and = 0.041, respectively). Error rates with pMDI alone only decreased significantly by the third visit ( = 0.04). Throughout all visits, MDI PLUS consistently showed fewer errors than AeroChamber2go, although this difference did not reach statistical significance ( > 0.05). Regarding clinical outcomes, both spacer groups experienced significant, visit-to-visit improvements in FEV% of predicted, PEF% of predicted, and ACT scores (all < 0.05 between visit 1 and 2 and between visit 2 and 3). In contrast, the pMDI alone group showed no significant change between visits 1 and 2, with statistically significant improvement only by visit 3 (FEV, = 0.04; PEF, = 0.03; ACT, = 0.04). CONCLUSION: Counseling asthmatic patients with either spacer has significantly reduced inhalation errors and provided greater and earlier improvements in terms of lung function and asthma control compared to pMDI alone.