BackgroundNonadherence to medication and incorrect use of inhalers represent significant barriers to optimal disease management of patients with chronic obstructive pulmonary disease (COPD). Thus, health care professionals (HCPs) play a critical role in educating their patients on appropriate inhaler use and in ensuring medication adherence. However, many patients do not receive appropriate inhaler training or have not had their inhaler technique checked.MethodsThe Real-life Experience and Accuracy of inhaLer use (REAL) survey was a computer-assisted, telephonic survey consisting of 23 questions gathering real-world information on correct inhaler use, inhalation technique, device attributes, adherence, dosing accuracy, training, correct device use, ease of use, and factors that influence patient adherence in commercially available inhalers delivering COPD maintenance therapy. All results are based on patient-reported data.ResultsThe survey was conducted between January 4, 2016 and February 2, 2016. A total of 764 patients using various inhalers (Breezhaler® =186; Ellipta® =191; Genuair® =194; Respimat® =201) with mild to very severe COPD, with a mean ± SD age 56±9.8 years, completed the survey. Patient self-reported adherence was significantly lower in younger patients compared to older patients (p=0.020). Eighty-three percent of patients indicated that a demonstration (in-person) was “very helpful” versus 58% for video. Patient preferences for training methods were as follows: demonstration of inhaler use (83%), video (58%), instructions for use (51%), and leaflet (34%). Twenty-nine percent of patients had not been checked to see if they were using their device correctly by a HCP within the last two years. Patients who were checked were significantly more adherent than unchecked patients (p=0.020). The majority of the patients using Breezhaler reported either being very confident or confident of having taken a full dose, which was higher than those using Genuair, Ellipta (α=0.05), and Respimat (α=0.05). Treatment adherence in the last 30 days was highest with Breezhaler followed by Respimat, Ellipta, and Genuair.ConclusionThe REAL survey identified attributes that influenced patient adherence and optimal inhaler use. Predictive attributes that influence patient adherence which HCPs should be aware of include age and disease severity. Modifiable attributes which the HCP can influence include correct inhaler use training, choice of training methods, checking patient inhaler technique at subsequent visits, and device selection. Inhalers are integral in the effective management of patients with COPD; it is therefore important that patients use the inhaler correctly and have full confidence in the dosage.

Background: Good compliance in chronic obstructive pulmonary disease (COPD) is of 'paramount importance' in reducing the occurrence of acute exacerbations, hospitalisation and mortality and in improving quality of life. However, a number of studies have confirmed that long-term compliance is low and often associated with difficulties in handling maintenance inhalers. Therefore, the easier an inhaler is to use, the more likely the patient will comply with handling instructions and so, optimise control of the condition. A research study was undertaken comparing the maintenance inhalers Breezhaler TM (BHavailable in combination with Ultibro, Seebri and Onbrez from Novartis) and Respimat TM (RM-available in combination with Spiriva, Spiolto and Striverdi from Boehringer Ingelheim). Methods: The research was conducted among 240 maintenance inhaler-naive participants who before handling the inhalers were asked to indicate how important they felt it was that an inhaler offered each of a list of 22 handling-related attributes. They then handled each inhaler on three separate occasions familiarising themselves with the correct handling procedure by consulting respective 'Instructions for use' and short training videos. Following the handling process, participants rated the individual inhaler against each of the 22 attributes and finally expressed their preference between the two on a number of key handling-related attributes and indicated which they preferred overall. Results: A significant majority of participants preferred BH to RM overall. BH was rated statistically superior on 20 of the 22 handling-related attributes particularly those participants rated most highly including dosing confidence, 'easy to use' and 'easy to learn'. Conclusions: Significantly more participants were confident that BH would deliver a full dose of medication and was easier to learn and use. These attributes are crucial for achieving improved patient compliance. As a result, BH offers an opportunity for improved symptom control in the maintenance treatment of COPD.

No abstract

and similar/better exacerbation prevention has been demonstrated with LABA/LAMA combination 3,4 , thus providing an ICS-free pharmacotherapy option. In partnership with IPCRG, a desktop helper was created to educate and guide clinicians on appropriateness of using ICS therapy and ICS withdrawal in COPD patients, when appropriate. Methods: Literature reviews were conducted in order to create algorithms to: determine appropriateness of ICS therapy; provide a stepwise process for ICS withdrawal to maximise outcomes and minimize harm. An existing algorithm 5 was modified to improve clinical utility, while ensuring appropriate safety. The algorithm utilized the data from the FLAME and WISDOM studies that support switching from LABA/ICS or triple therapy to LABA/LAMA 3,4. The algorithm also describes required follow-up to minimize risk during ICS withdrawal. Results: The algorithm would identify patients with COPD and who might benefit from ICS treatment and patients in whom this treatment may not be appropriate; and an approach to withdrawing ICS in those patients who do not need ICS is provided (figure). This clear, practical, and efficient process of guidance, in addition to new guidelines and evidence, would encourage clinicians to make changes in current therapy. Implementation will require a significant change in thinking and behaviour of cli-nicians, and clear communication on: why change (evidence); who says (guidelines); and who supports (IPCRG). Conclusion: The desktop helper would help clinicians in reducing inappropriate exposure to ICS in COPD patients, while effectively managing symptoms and exacerbation risk. Figure. Desktop helper A. Algorithm on appropriateness of ICS therapy; B. Stepwise process of ICS withdrawal in suitable patients; C. Guidance on switching doses upon changing treatments REFERENCES 1. Price D, et al. Prim Care Respir Background and Aims: Many patients with COPD achieve incomplete benefit from their treatment, due to inadequate device training or incorrect inhaler technique. Inhaler overuse/underuse are the most common forms of nonadherence, leading to inhaler use errors and may negatively impact treatment adherence. This computer-assisted telephonic survey evaluated patient-reported insights on inhaler/medication use, device attributes and overall adherence. Methods: Patients with mild-to-very severe COPD using maintenance inhaled treatment were included. Patient-reported data on correct inhaler use (training and check), inhalation pattern, and device attributes (ease of use and confidence of inhaling full dose), adherence and potential underuse/overuse were collected. Results: A total of 764 patients* (Breezhaler ® , 186; Ellipta ® , 191; Gen-uair ® , 194; Respimat ® , 201) with a meanAESD age 56AE9.8 years, completed the survey. Approximately, 30% of patients reported not receiving any inhaler use training. Majority of the patients found different training materials "very helpful" (Figure). About 29% of patients reported never being checked for correct inhaler technique. Most pat...