A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices

Abstract

Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P<0.001). Most patients (57–70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P=0.221); MDI (2/32 (6%) vs 8/32 (25%), P=0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P<0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers.

Inhaler Devices for Delivery of LABA/LAMA Fixed-Dose Combinations in Patients with COPD

“…In an assessment of critical inhaler technique errors with Genuair Ò and Breezhaler Ò after 2 weeks of daily use, the proportion of patients making these errors was low with both Genuair Ò and Breezhaler Ò [84]. When compared with other inhalers, fewer COPD patients had at least one overall error using the Ellipta Ò inhaler compared with the Handihaler Ò or Breezhaler Ò ; a larger proportion of patients rated the Ellipta Ò inhaler very easy or easy to use compared with the Handihaler Ò or the Breezhaler Ò [85]. A cross-sectional study examined specific patient characteristics and device attributes that are associated with poor handling technique among patients with COPD who used at least one of the following devices: MDI, Diskus Ò , and Handihaler Ò [86].…”

The Ellipta ® in Asthma and Chronic Obstructive Pulmonary disease: Device Characteristics and Patient Acceptability

“…Critical errors, time needed for instruction, ease-of-use and patient preference for Ellipta Critical errors, time needed for instruction, ease-of-use and patient preference have recently been assessed in a randomised, open-label, multicentre crossover study in 729 patients with asthma or COPD [22]. Inhaler naïve patients were assigned to inhale Ellipta vs Diskus, metered dose inhaler (MDI), Turbuhaler, Handihaler or Breezhaler.…”

“…Preference was highest for the dose-counter size (68% vs 20%), number of steps needed to use the inhaler (67% vs 23%) and for the once daily dosing regimen (67% vs 23%). Reproduced from reference [22] Qualitative assessment through the use of semi-structured interviews has been performed on 75 patients with asthma and COPD who had recently completed a phase IIIa clinical trial of the Ellipta inhaler [24] . Participants were asked about their satisfaction of the device and how they would rate the inhaler on a subjective 1-10 scale.…”

The epoch of dual bronchodilation: the first direct comparisons and meta-analyzes

“…Среди преимуществ ДПИ Эллипта экспертами отмечены отсутствие необходимости координации действий при использовании устройства (57,4 %), малое количество действий для совершения ингаляции (45,7 %), отсутствие механизма контроля правильности маневра (51,1 %), низкую фракцию мелких частиц (31,9 %) [27]. ДПИ Эллипта характеризовался самой низкой частотой критических ошибок в сравнении с ДАИ, препаратами Мультидиск, Турбухалер, Бризхалер и ХандиХалер [30]. Следует отметить, что по данным крупного исследования [29] (n = 2 935), при допущении критических ошибок в технике ингаляции статистически значимо увеличивается риск тяжелых обострений ХОБЛ.…”