Dry-powder inhalers in patients with persistent airflow limitation: usability and preference

Abstract

BackgroundInhalation devices represent per sé critical factors because they can affect the therapeutic outcomes independently of the drug used. The role of patients’ usability and preference (PUP) for Dry Powder Inhalers (DPIs) is high indeed because they can influence the extent of the adherence to treatment and the therapeutic outcomes.Aim of the study was to assess and compare the PUP of three different DPIs in out-patients with persistent airflow limitation due to asthma or COPD.MethodsThe PUP of three different DPIs (Breezhaler; Genuair; Handihaler) were investigated by means of the Handling Questionnaire in out-patients with persistent airflow limitation needing an inhalation therapy. Patients had to report their preference before and after the nurse’s instruction on the handling of each device. The nurse had also to note the critical steps during the patient’s procedure for actuation; to count the number of attempts needed for actuating the device properly, and to measure the time (in sec.) required for these procedures. Data were collected up to three attempts per device.Statistics: Welch test was used for normal distributed variables, while the Wilcoxon test for not normal distributed variables. The χ2 test and the ANOVA test were also used. Univariate and multivariate regressions were also performed in order to investigate the effect of patients’ characteristics and of technical differences of each device on their proper use.ResultsThree hundred thirty-three consecutive out-patients (age range 55–58 years, and well matched for gender), with persistent airway limitation of different severity were investigated, suffering from bronchial asthma (n = 175) or from chronic obstructive pulmonary disease (COPD) (n = 158). In particular, 127 patients (38 %) tested the three DPIs, while 110 (33 %) tested Breezhaler and Genuair, and 96 (29 %) Breezhaler and Handihaler. More than 50 % of patients who tested all devices preferred the Genuair and perceived this device as the easiest to use. The nurse’s judgement confirmed their opinion. When compared to the other two DPIs, Genuair proved the least problematic either according to the patients’ judgement and to the nurse’s opinion. Mean number of attempts aimed to achieving the first proper actuation was lower with Genuair than with Breezhaler and Handihaler (1.5 vs 2.5–2.6, p < 0.0001). Finally, Genuair also proved the easiest to use and the least problematic according to the nurse judgement (0.0001), the most easily learned (0.0001), and that one with a successful rate of more than 56 % at the first attempt. Breezhaler and Handihaler needed an average of about one additional attempt to be used properly (p < 0.0001), and their usability proved significantly more difficult (OR of successful rate between 0.15 and 0.17, p < 0.001). In general, older patients needed more attempts to perform their first proper inhalation; their successful rate was lower, and they needed more time to learn how to use devices properly: with Genuair these differences were minimized.Conclusions...

The Global Usability Score: A Novel Comprehensive Tool for Assessing, Ranking, and Compare Usability of Inhalers in Patients Requiring Airway Treatments

“…These results were confirmed in the elderly by another study which mainly investigated the patients' acceptance, but also performed some measurements of the time required to actuate the proper inhalation [28].…”

“…When this questionnaire was adopted for comparing usability of different inhalers, substantial discrepancies clearly appeared among the patients' perception and beliefs (also after instruction), and their real usability of inhalers after direct practicing [28]. These results were confirmed in the elderly by another study which mainly investigated the patients' acceptance, but also performed some measurements of the time required to actuate the proper inhalation [28].…”

Peak inspiratory flow in children and adolescents with asthma using dry powder inhalers: a cross-sectional study

“…It is known that factors related to patient experience with the inhalation maneuver are related to changes attributable to a learning effect. 21 , 22 Nevertheless, PIF values were significantly lower in the children and adolescents with asthma, who had to perform the inhalation maneuver on a daily basis, than in the healthy controls, who had never had to perform such a maneuver. This can be explained by the pathophysiology of asthma, which is associated with airway obstruction (particularly small airway obstruction), airway remodeling, or a combination of the two.…”

“…Sabe-se que fatores relacionados à experiência do paciente com a manobra de inalação estão relacionados a alterações nos valores pelo efeito de aprendizado. (21,22) A despeito disso, mesmo quando comparando crianças e adolescentes com asma que realizam a manobra de inalação diariamente com crianças e adolescentes saudáveis que nunca tiveram contato com tal manobra, os valores foram significativamente inferiores nos asmáticos. Essa redução pode ser explicada pela fisiopatologia da doença, que está associada à obstrução das vias aéreas, especialmente aquelas de menor calibre e/ou com algum grau de remodelamento.…”

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“…Patients' perceptions and empowerment were highly valued from this point of view, even if only a few studies investigated and assessed the correspondence between the patients' beliefs and the effective usability of DPIs in real-life by means of specific and comprehensive instruments [13,[22][23][24].…”