Ease-of-use preference for the ELLIPTA® dry powder inhaler over a commonly used single-dose capsule dry powder inhaler by inhalation device-naïve Japanese volunteers aged 40 years or older

Abstract

BackgroundIn patients receiving inhaled medication, dissatisfaction with and difficulty in using the inhaler can affect treatment adherence. The incidence of handling errors is typically higher in the elderly than in younger people. The aim of the study was to assess inhaler preference for and handling errors with the ELLIPTA® dry powder inhaler (DPI), (GSK), compared with the established BREEZHALER™, a single-dose capsule DPI (Novartis), in inhalation device-naïve Japanese volunteers aged ≥40 years.MethodsIn this open-label, nondrug interventional, crossover DPI preference study comparing the ELLIPTA DPI and BREEZHALER, 150 subjects were randomized to handle the ELLIPTA or BREEZHALER DPIs until the point of inhalation, without receiving verbal or demonstrative instruction (first attempt). Subjects then crossed over to the other inhaler. Preference was assessed using a self-completed questionnaire. Inhaler handling was assessed by a trained assessor using a checklist. Subjects did not inhale any medication in the study, so efficacy and safety were not measured.ResultsThe ELLIPTA DPI was preferred to the BREEZHALER by 89% of subjects (odds ratio [OR] 70.14, 95% confidence interval [CI] 33.69–146.01; P-value not applicable for this inhaler) for ease of use, by 63% of subjects (OR 2.98, CI 1.87–4.77; P<0.0001) for ease of determining the number of doses remaining in the inhaler, by 91% for number of steps required, and by 93% for time needed for handling the inhaler. The BREEZHALER was preferred to the ELLIPTA DPI for comfort of the mouthpiece by 64% of subjects (OR 3.16, CI 1.97–5.06; P<0.0001). The incidence of handling errors (first attempt) was 11% with ELLIPTA and 68% with BREEZHALER; differences in incidence were generally similar when analyzed by age (< or ≥65 years) or sex.ConclusionThese data, obtained in an inhalation device-naïve population, suggest that the ELLIPTA DPI is preferred to an established alternative based on its ease-of-use features and is associated with fewer handling errors.

How many instructions are required to correct inhalation errors in patients with asthma and chronic obstructive pulmonary disease?

“…As far as the new device Ellipta ® was concerned, misuse in device handling was far less frequent (3%), but inhalation errors were similar (70%) compared to any other device. Likewise, Komase et al reported an 11% frequency of erroneous operations in device handling; however, their evaluation was limited to device handling and did not include inhalation-related actions [19].…”

A Network Meta-Analysis of Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting β2-Agonist (LABA) Combinations in COPD

“…However, as the majority (40/44) of the studies included in the NMA were blinded, it is unlikely that these differences in inhaler type would be reflected in the results. Currently, while several studies have identified patient preferences between different inhaler types [53][54][55], there is limited evidence to demonstrate any differences in efficacy outcomes [56,57]. Further research is therefore required to inform optimal device design, improve compliance, reduce handling errors and, ultimately, improve outcomes.…”

Long-acting muscarinic antagonists

“…In TABLE 7, the author has reported some studies where LAMA/device systems are compared in terms of preference, usability, inhaler use, satisfaction with use and willingness to continue the inhaler use [49,75,135,[142][143][144][145][146][147][148][149][150][151][152][153][154][155][156][157]. Unfortunately, these outcomes were assessed in various ways, ranging from a simple question to non-validated and validated proprietary questionnaires.…”