***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve r and omised trial was performed to evaluate the effectiveness of an asthma education programme administered by an asthma nurse specialist in an out-patient setting . Sixty asthmatic patients ( mean age 28.5 years ) were enrolled , 30 to a  usual care control group and 30 to an  education group . The education group underwent an individual education programme lasting at least one hour . The following variables were measured at baseline , one month after the education programme and at one year follow-up : asthma knowledge by MCQ ( 36 point question naire ) , inhaler technique ( 7 point scale ) , peak expiratory flow rate ( PEFR ) and symptomatology by visual analogue score ( 0 to 10 score ) . The education group 's inhaler technique and MCQ score both improved significantly at one month , from 5.4 ( 0.3 ) ( mean [ SEM ] ) to 6.5 ( 0.3 ) , p < 0.001 , and from 7.5 ( 2.4 ) to 22 ( 1.8 ) , p < 0.0001 respectively . Both of these improvements were significantly greater than in the control group , and both were maintained at one year follow-up . The symptom score improved over one year in the education group , from 5.4 ( 0.6 ) to 7.6 ( 0.5 ) , p < 0.05 , and was unchanged in the control group . There was no change in the PEFR in either group . This study shows clear objective benefits to an out-patient asthma education programme conducted by an asthma nurse specialist Optimal effects of asthma medications are dependent on correct inhaler technique . In a telephone survey , 77/87 patients reported that their Turbuhaler technique had not been checked by a health care professional . In a subsequent pilot study , 26 patients were r and omized to receive one of 3 Turbuhaler counseling techniques , administered in the community pharmacy .  Turbuhaler technique was scored before and 2 weeks after counseling ( optimal technique = score 9/9 ) . At baseline , 0/26 patients had optimal technique . After 2 weeks , optimal technique was achieved by 0/7 patients receiving st and ard verbal counseling ( A ) , 2/8 receiving verbal counseling augmented with emphasis on Turbuhaler position during priming ( B ) , and 7/9 receiving augmented verbal counseling plus physical demonstration ( C ) ( Fisher 's exact test for A vs C , p = 0.006 ) . Satisfactory technique ( 4 essential steps correct ) also improved ( A : 3/8 to 4/7 ; B : 2/9 to 5/8 ; and C : 1/9 to 9/9 patients ) ( A vs C , p = 0.1 ) . Counseling in Turbuhaler use represents an important opportunity for community pharmacists to improve asthma management , but physical demonstration appears to be an important component to effective Turbuhaler training for educating patients toward optimal Turbuhaler technique BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea Background Spiromax ® is a novel dry-powder inhaler containing formulations of budesonide plus formoterol ( BF ) . The device is intended to provide dose equivalence with enhanced user-friendliness compared to BF Turbuhaler ® in asthma and chronic obstructive pulmonary disease ( COPD ) . The present study was performed to compare inhalation parameters with empty versions of the two devices , and to investigate the effects of enhanced training design ed to encourage faster inhalation . Methods This r and omised , open-label , cross-over study included children with asthma ( n = 23 ) , adolescents with asthma ( n = 27 ) , adults with asthma ( n = 50 ) , adults with COPD ( n = 50 ) and healthy adult volunteers ( n = 50 ) .  Inhalation manoeuvres were recorded with each device after training with the patient information leaflet ( PIL ) and after enhanced training using an In-Check Dial device . Results After PIL training , peak inspiratory flow ( PIF ) , maximum change in pressure ( ∆P ) and the inhalation volume ( IV ) were significantly higher with Spiromax than with the Turbuhaler device ( p values were at least < 0.05 in all patient groups ) . After enhanced training , numerically or significantly higher values for PIF , ∆P , IV and acceleration remained with Spiromax versus Turbuhaler , except for ∆P in COPD patients . After PIL training , one adult asthma patient and one COPD patient inhaled < 30 L/min through the Spiromax compared to one adult asthma patient and five COPD patients with the Turbuhaler . All patients achieved PIF values of at least 30 L/min after enhanced training . Conclusions The two inhalers have similar resistance so inhalation flows and pressure changes would be expected to be similar . The higher flow-related values noted for Spiromax versus Turbuhaler after PIL training suggest that Spiromax might have human factor advantages in real-world use . After enhanced training , the flow-related differences between devices persisted ; increased flow rates were achieved with both devices , and all patients achieved the minimal flow required for adequate drug delivery . Enhanced training could be useful , especially in COPD patients Background : Patient knowledge of correct inhaler technique is essential in the treatment of pulmonary disease . Computer delivery of educational content may augment existing teaching efforts . Objective : To determine whether a computer-based tutorial on inhaler technique could improve patients ' knowledge and ability to correctly demonstrate inhaler technique . Methods : A total of 34 adults with pulmonary disease and experience using inhalers were r and omized into the control or intervention groups . The intervention group viewed the tutorial , after which they demonstrated their inhaler technique and completed an Inhaler Technique Knowledge Test . Control group patients , who did not view the tutorial , were also evaluated on their demonstrated inhaler technique and technique knowledge . Additional information obtained included demographics , illness and treatment history , and patients ' use of computers . Lastly , all patients who viewed the tutorial completed a brief question naire eliciting tutorial feedback . Control group patients were invited to view the tutorial after other data collection was complete . The 2 principal outcomes were the observed inhaler technique score and the inhaler technique knowledge test score . Comparisons between groups were conducted using Student 's t-test and χ2 test , with a p value less than 0.05 considered statistically significant . Results : Eighteen subjects were enrolled in the computer group ; 16 were in the control group . The intervention group demonstrated significantly better inhaler technique , with a mean Observed Inhaler Technique Score of 88.3 ± 12.3 compared with 67.4 ± 19.2 for the control group ( p = 0.001 ) . The intervention group also scored significantly higher on the Inhaler Technique Knowledge Test , with a score of 80.9 ± 17.0 versus 67.4 ± 11.8 for the control group ( p = 0.01 ) . Overall , the program appeared acceptable to patients . Conclusions : Patients in the tutorial group demonstrated better inhaler technique and scored higher on the Inhaler Technique Knowledge Test compared with those in a control group . This tutorial may be a useful educational tool to enhance patient education regarding inhaler technique Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients Background : The most common treatment for asthma is transferring the drug into the lungs by inhaler devices . Besides , correct use of inhaled medication is required for effectiveness of pharmacotherapy . Thus , it is necessary to train the patients how to use Metered Dose Inhaler ( MDI ) . This study aim ed to determine the effect of training about MDI usage with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients . Methods : This r and omized clinical trial was conducted on 90 asthmatic patients who were r and omly divided into inhalation technique group with spacer , inhalation technique group without spacer , and a control group . Then , the Peak Expiratory Flow Rate ( PEFR ) was measured using a peak flow meter , as a basic test . In addition , the patients ’ functional skills of inhalation technique were assessed using two checklists . Afterwards , 3 sessions of training were arranged for both groups . PEFR and the ability to use the MDI were evaluated immediately and 1 month after the intervention . Finally , the data were entered into the SPSS statistical software ( v. 18 ) and analyzed using independent t-test and repeated measures ANOVA . Results : After the intervention , MDI usage skills improved in the two intervention groups compared to the control group ( P<0.001 ) . In addition , a significant difference was found between the intervention groups and the control group regarding the mean of PEFR after the intervention ( P<0.001 ) . However , no significant difference was observed between the two intervention groups ( P=0.556 ) . Conclusion : According to the results , providing appropriate training for asthmatic patients increased MDI usage skills , and both methods of inhalation ( with or without spacer ) could improve the PEFR among the patients . Trial Registration Number : I RCT Many children with asthma do not use the st and ard metered-dose inhaler ( MDI ) skillfully . To improve drug delivery , correct problems of h and -lung incoordination , and reduce local side effects , a number of spacer devices have been developed . We evaluated one such device , a tube spacer ( Aerochamber ) , in 16 asthmatic children ( 5 to 12 years ) . On four separate days and in a r and omized , double-blind , placebo-controlled manner , they received either metaproterenol sulfate by MDI aerosol ( 130 micrograms ) or placebo with and without the tube spacer . To maximize techniques , at each visit the children had proper instructions , including viewing a videotape . Spirometry was performed at baseline and 5 , 15 , and 30 minutes , and hourly for six hours , and the patient was monitored . Analysis of the entire group ( forced expiratory volume at 1 s and midmaximal expiratory volume ) revealed no difference between metaproterenol administered with or without the tube spacer , and both were significantly different than placebo through two hours . Six children had longer and three had better bronchodilatation with the MDI plus tube spacer than with the MDI alone . Side effects and vital signs did not differ between treatments . Under the circumstances of our study , the tube spacer device might enhance the use of the MDI in children who are not properly taught and /or who forget or can not perform proper technique OBJECTIVES To compare the effectiveness of small-group training in correct inhaler technique with self-directed Internet-based training . DESIGN Pharmacy students were r and omly allocated to 1 of 2 groups : small-group training ( n = 123 ) or self-directed Internet-based training ( n = 113 ) . Prior to intervention delivery , all participants were given a placebo Turbuhaler and product information leaflet and received inhaler technique training based on their group .  Technique was assessed following training and predictors of correct inhaler technique were examined . ASSESSMENT There was a significant improvement in the number of participants demonstrating correct technique in both groups ( small group training , 12 % to 63 % ; p < 0.05 ; and Internet-based training , 9 % to 59 % ; p < 0.05 ) post intervention , with no significant difference between the groups in the percent change ( n = 234 , p > 0.05 ) . Increased 
    Output:
    
Enhanced inhaler technique education and multi-media training improved technique in most studies immediately after the intervention and at follow-up , although the variety of checklists used meant that this was difficult to assess reliably .
For both adults and children , how and when inhaler technique was assessed appeared to affect whether inhaler technique improved and by how much .
Analyses of the numbers of people who demonstrated correct or ' good enough ' technique were generally more useful than checklist scores .
Inhaler technique interventions provided some benefit for asthma control and quality of life but generally did not lead to consistent or important clinical benefits for adults or children .
Responder analyses sometimes showed improvement among more people in the intervention groups , even though the mean difference between groups was small .
We found no evidence about harms .
Most included studies did not report important improvement in clinical outcomes .
Guidelines consistently recommend that clinicians check regularly the inhaler technique of their patients ; what is not clear is how clinicians can most effectively intervene if they find a patient 's technique to be inadequate , and whether such interventions will have a discernible impact on clinical outcomes