Comparison of Patient Preference and Ease of Teaching Inhaler Technique for Pulmicort Turbuhaler^®versus Pressurized Metered-Dose Inhalers

Abstract

A multicenter, randomized, open-label, crossover study with two 4-week evaluation periods compared patient preference and ease of teaching correct inhaler technique for Pulmicort Turbuhaler versus pressurized metered-dose inhalers (pMDIs). Patients 18 to 65 years of age with stable, mild to moderate asthma, who required or were eligible for inhaled corticosteroid therapy, were randomized to treatment sequences consisting of 4-week evaluation periods with Pulmicort Turbuhaler (budesonide inhalation powder) two puffs (400 microg) bid and one of three inhaled corticosteroids via pMDI: Aerobid-M (flunisolide) four puffs (1 mg) bid, Flovent (fluticasone propionate) two puffs (440 microg) bid, or Vanceril Double Strength (beclomethasone dipropionate) five puffs (420 microg) bid. Patients indicated device preference at study end and completed the Patient Device Experience Assessment (PDEA) questionnaire after each evaluation period. Ease of teaching, time required to master use of the device, percentage of patients demonstrating mastery on the first attempt, and the number of attempts required to demonstrate mastery were assessed. Despite previous use of pMDIs by most patients, Pulmicort Turbuhaler was significantly preferred (p < 0.001) and required significantly less time to master than pMDIs (p < 0.001). Median times to device mastery were 3.67 min for Pulmicort Turbuhaler versus 5.33 min for pMDIs. Patients rated Pulmicort Turbuhaler significantly better than pMDIs on PDEA ease of use (p = 0.0005) and overall satisfaction (p < 0.0001) single-item scales and all four multi-item scales (pharyngeal symptoms, oral sensation, operational use, and inhaler attributes; p < 0.05). Overall, patients preferred Pulmicort Turbuhaler over pMDIs and required less time to be taught how to correctly use Turbuhaler trade mark.

Real-world asthma management with inhaler devices in Switzerland—results of the asthma survey

“…This is consistent with the recommendation not to switch between different inhalers, as each inhaler class and brand has its own unique requirements regarding handling and inhalation technique (29)(30)(31). In addition, patients do express preference for particular inhaler devices, which makes successful teaching easier (32,33). On the other hand, in D-CH, pMDI prescriptions were significantly more often triggered by patient age and by the presence of a low inspiratory flow than in W-CH, which is consistent with more technically objective reasons for prescribing and with the recommendation that choice of device should be based on the individual patient's natural inhaler technique, preferring an MDI in patients who naturally tend to breathe in slowly and preferring a DPI in those who tend to inspire hard and fast (7,11).…”

Time Required to Rectify Inhaler Errors Among Experienced Subjects With Faulty Technique

“…[4][5][6][7] As a consequence, the role of education from trained caregivers is important to reduce poor inhaler technique not only at the time of the first prescription but also at follow-up visits. 8,9 Many studies have evaluated the time required for educating naive adult users to inhaler mastery, [10][11][12][13][14][15][16][17] but, to our knowledge, no information is available to evaluate the re-education time required to achieve inhaler mastery in experienced users with faulty baseline technique. Our previous study, the GENEBI Project 2 , investigated home inhaler practice among experienced stable subjects with chronic obstructive airway diseases referred to chest clinics throughout Italy.…”

Patient preference for and satisfaction with inhaler devices

“…The next large group of trials involved comparisons with the dry powder inhaler, Turbuhaler TM (AstraZeneca, Lund, Sweden; table 3) [14][15][16][17][18][19][20][21][22][23][24]. This group included 11 trials, all in asthma patients; nine of them were sponsored by AstraZeneca.…”

“…Only four of the 11 trials used the same drug in the two devices being compared; the others compared different drugs of the same class, such as inhaled corticosteroids, or short-or long-acting bronchodilators. The assessments were primarily made by questionnaire and one study used a 25-item questionnaire developed according to standards of psychometric testing (Patient Device Experience Assessment (PDEA)) by an independent outcomes research organisation [20]. In seven of the nine trials sponsored by AstraZeneca, the Turbuhaler TM was the preferred device when overall preference was assessed.…”

“…Most of the questionnaires in the reviewed studies were developed without input from patients or experts in psychometric testing. Only two questionnaires were developed by outcomes experts and then tested in the field: the PDEA and the PASAPQ [20,25]. Only the PASAPQ has a published validation, which includes a determination of minimally important difference, a very important feature for discriminating the degree of difference that is clinically significant [33].…”