Inhaler devices in asthma and COPD patients – a prospective cross-sectional study on inhaler preferences and error rates

Abstract

Background: Inhalation therapy is the backbone of asthma and COPD control. However, inhaler adherence and device mishandling continue to be a problem in real life. Some studies have shown that using a patient-preferred inhaler may reduce device handling errors and improve adherence to prescribed chronic inhaler drug therapy. The aim of this study was to compare the preferences for commonly used inhaler devices in Germany in patients with chronic obstructive respiratory disease. We also pursued the question which properties of an inhaler device are particularly important to the user and what effects age, gender and type of disease (asthma or COPD) may have on device preference and handling errors. Methods: Prospective, open-label cross-sectional study in which 105 patients with asthma (58%) or COPD (42%) participated. Validated checklists were used to objectively assess inhaler technique and errors with 10 different placebo devices. For each device, patients were asked to test the handling, to assess the device properties and to name the device that they would most or least prefer. Results: Across the 10 placebo inhaler devices tested, patients needed an average of 1.22 attempts to error-free use. The device with the lowest mean number of attempts was the Turbohaler® (1.02), followed by the Nexthaler® (1.04), the Diskus® (1.07) and the Spiromax® (1.10). Patients over 60 years vs. younger age (p = 0.002) and COPD vs. asthma patients (p = 0.016) required more attempts to ensure correct use. 41% of the study participants chose one of the devices they already used as the most preferred inhaler. Overall, 20% opted for the Spiromax®, 15% for the Nexthaler® and 14% for the Turbohaler® or a pMDI. The least preferred device was the Elpenhaler® (0%). From a selection of 7 predefined inhaler attributes, patients stated easy handling as the most important for them. This was followed by short inhalation time and low inhalation resistance. Conclusions: Patient preference may vary between inhaler devices. The lowest number of attempts to error-free use was reported for the Turbohaler® and the Nexthaler®. The Spiromax® and the Nexthaler® achieved the best overall ratings and were the devices most preferred by patients.

Exploring quality of life and satisfaction with treatment in asthmatic patients receiving dry powder inhalers: a multinational survey

“…These data highlight an unmet need in people with poor asthma-related QoL who seek user-friendly devices with clear feedback on correct drug administration. Our results, together with the findings of Hawken et al (15) and Schreiber et al (32), emphasize the need to improve the convenience, user-friendliness, and reliability of inhaler devices used to treat asthmatic patients.…”

“…Asthmatic patients from the Hawken series, placed most value on an inhaler that required one step for dose preparation rather than four steps, that is, was easy to use, gave a confirmation of the dose being taken, and could be used during episodes of breathing difficulties (15). Schreiber et al acknowledged that patients may vary in their inhaler preferences and established that the ease of handling, followed by short inhalation time and low inhalation resistance were the most important device features according to the patients included in their study (32). On the other hand, a recent study found that the fast relief of symptom and the reduction of exacerbation rate were considered the most important characteristics for asthma maintenance inhaler while ICS safety and device convenience were not identified as priority characteristic showing that patients put clinical efficacy in the first position (33).…”

Importance of Following Proper Inhalation Techniques and Awareness Regarding Asthma among Clinical Patients

“…Correct inhaler handling technique and device handling were contributed to symptom control of asthma. Ease of handling of inhaler is important to promote patient's acceptance [8]. This result confirms that many participants did not know to handle their inhalers correctly.…”

“…PMDI and DPI are each associated with their own advantages and disadvantages. The patient's preference for the inhaler device is determined by using the patient's skills preferences and experience with inhalers, available medication, and cost [8]. According to many studies, patients will not get the full value of their inhaled medications due to incorrect use of their inhalers, and it is considered to be a major public health problem [9].…”

“…Knowledge, adherence, and inhaler techniques are the main areas of asthma education [10]. The most common error for experienced patients with asthma was device mishandling [8]. Correct inhalation techniques can exert a beneficial impact in achieving appropriate health outcomes in patients receiving anti-asthma medicines for inhalation [11].…”