Handling of and Preferences for Available Dry Powder Inhaler Systems by Patients with Asthma and COPD

Abstract

The correct handling of dry powder inhalers (DPIs) is crucial for efficient therapy, and acceptance of the device can improve compliance. The handling of seven different dry powder inhalers was studied in 72 patients with asthma and chronic obstructive pulmonary disease (COPD). The aim of this study was to identify possible handling errors and investigate patient preferences. Patients inhaled twice with each inhaler; first after reading the device leaflet, and second after device handling was explained by the investigator. The investigator identified handling errors and critical handling errors, which might lead to insufficient or no dose delivery. Afterward, the patients selected their preferred device and judged different aspects of device handling. The lowest number of patients with critical handling errors was observed for the Diskus/Accuhaler, the highest numbers for the Jethaler and the Easyhaler (% of patients during first/second use): Diskus/Accuhaler 25%/13.9% (group A) and 38.9%/8.3% (group B); Clickhaler 50.0%/52.8%, Cyclohaler 58.3%/13.9%, Jethaler 66.7%/30.6% (group A) and Benosid N Inhaler 52.8%/22.2%, Novolizer 52.8%/25.0%, Easyhaler 72.2%/47.2% (group B). Device handling improved after instruction by the investigator. Device handling and preferences of patients closely correlated in this study. Both devices producing the lowest numbers of handling errors (Diskus/Accuhaler and Clickhaler) had the highest preference by the subjects (score from 1 = very good to 7 = very bad): Diskus/Accuhaler 2.21 (group A) and 2.02 (group B); Clickhaler 2.21, Cyclohaler 2.80, Jethaler 3.16 (group A); Novolizer 2.33, Easyhaler 2.37, Benosid N Inhaler 2.43 (group B). Critical handling errors may reduce therapy outcome due to a reduced dose delivery. In addition, reduced patients acceptance of a device, being dependent on device handling, may have a similar effect by reducing patients' compliance.

The knowledge and considerations of the physicians regarding the inhaler devices in asthma and COPD: the INTEDA-1 study

“…Among the preferred ways of inhaler training were demonstration (56.3%), video (19%), and brochures and leaflets (18%) (16). The studies concerned have showed that correct device handling has to a large extent improved the therapeutic outcomes (17).…”

Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers

“…In turn, devices associated with the lowest numbers of handling errors have the highest patient preference ratings [12,13], suggesting that a patient’s acceptance of a device may be correlated with ease of handling. Therefore, device handling, correct inhaler technique, patient preference, and adherence are intertwined factors that all contribute to good symptom control.…”

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

“…Usually, the patients' skill in the device practicality, as well as their knowledge of the operational manoeuvres consenting the proper and effective inhalation of the drug emitted are inadequate [13]. As a consequence, the causes of patients' incorrect inhalation procedures and the determinants of patients' preference and acceptance had been extensively investigated, mainly being the patient's confidence and beliefs highly valued and regarded as the very crucial steps of the process to improve [9,15].…”

“…In particular, the determinants of patients' incorrect inhalation procedures [7,8] and those of patients' preference, acceptance, and satisfaction focused the attention of the majority of researchers [9][10][11][12][13][14][15]. The primary role of patients' viewpoint was then highly valued in recent years, even if the attempts to quantify objectively the correspondence between patients' beliefs and real usability in real life by means of specific instruments were only episodically pursued [11,[16][17][18][19].…”