Factors associated with appropriate inhaler use in patients with COPD – lessons from the REAL survey

Abstract

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.

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

“…Such differences may be linked to the larger mouthpiece of the Breezhaler Ò as well as to the ability for patients to visually confirm if any powder is left in the capsule after each actuation. These results were confirmed in the recent Real life Experience and Accuracy of inhaLer use (REAL) survey conducted in patients with COPD, which gathered insights into real-life inhaler use by patients and healthcare providers, device attributes, and training [77]. The majority of patients using Breezhaler Ò reported either being very confident or confident of having taken a full dose, which was higher than those using Genuair Ò , Ellipta Ò , and Respimat Ò .…”

“…The majority of patients using Breezhaler Ò reported either being very confident or confident of having taken a full dose, which was higher than those using Genuair Ò , Ellipta Ò , and Respimat Ò . However, this study also identified a low incidence of patient training and monitoring by healthcare providers for correct inhaler use [77]. In the recently reported INHALATOR study, a significantly greater proportion of patients expressed preference for Breezhaler Ò than for Respimat Ò (57.1% versus 30.1%) [78].…”

“…Treatment compliance in long-term disease management may be improved by educating patients and physicians on the correct use of inhaler devices. In this regard, studies such as the REAL survey have attempted to assess the effectiveness of patient/ healthcare provider training on correct inhaler use [77]. Poor inhalation technique, number of inhalation steps, clinical setting, and time elapsed since training were shown to have an impact on the effectiveness of the educational/training intervention [77].…”

Elevada frequência de erros na técnica inalatória entre pacientes com DPOC grave: um estudo de vida real

“…O manejo correto dos dispositivos inalatórios é fundamental para deposição pulmonar eficiente dos agentes farmacológicos, e consequentemente, para a efetividade do tratamento da doença. 1,2 Entretanto, muitos pacientes podem não utilizar corretamente os inaladores. A técnica inalatória incorreta é associada a desfechos negativos, pior qualidade de vida e maior utilização dos recursos de saúde em pacientes com DPOC.…”

“…A técnica inalatória incorreta é associada a desfechos negativos, pior qualidade de vida e maior utilização dos recursos de saúde em pacientes com DPOC. [1][2][3][4] Dados sobre o manuseio dos dispositivos inalatórios entre indivíduos com DPOC são escassos em nosso meio, sobretudo, no contexto da prática clínica. O objetivo do estudo foi avaliar o domínio da técnica entre pacientes com DPOC grave em uso de dois diferentes dispositivos inalatórios (Respimat ® e Diskus ® ).…”