Patterns of use of dry powder inhalers versus pressurized metered-dose inhalers devices in adult patients with chronic obstructive pulmonary disease or asthma: An observational comparative study

Abstract

Numerous patients with chronic obstructive pulmonary disease (COPD) and asthma do not use inhaler devices properly, which can contribute to poor disease control. The objective of this study is to assess the technical and safety use of dry powder inhalers (DPIs) versus pressurized metered-dose inhalers (MDIs) in adult patients with COPD or asthma in Lebanon. A concurrent, prospective comparative observational study was conducted at one hospital and 15 community pharmacies in Lebanon. Over a period of 18 months, 246 questionnaires were filled. Patients included were adults with COPD or asthma. Answers were entered into the Statistical Package for Social Sciences software and excel sheet. T-test and correlation were used to analyze the results; 67.8% and 38.4% of those using DPIs and MDIs, respectively, performed the exact technical steps adequately (p = 0.003, relative risk: 2.134, 95% confidence interval: 0.910–4.842). When compared to MDI, a higher percentage of DPI users found their devices easy to use. Moreover, 81.4% of the MDI users found difficulty in coordinating between pressing the canister and inhaling. Rates of exacerbations were significantly higher in MDIs vs. DPI users (59.4% vs. 21.7%). Overall, 44.31% of patients did not receive education from their healthcare professionals about the devices. A significant number of COPD/asthma adult patients do not use their devices properly. Even though DPIs were significantly easier to use, proper education on the technical use of all types of inhalers is needed.

Effectiveness and Patient Satisfaction with Budesonide/Formoterol Easyhaler® Among Patients with Asthma or COPD Switching from Previous Treatment: a Real-World Study of Patient-Reported Outcomes

“…Aerosol inhalation is considered the primary route of administering medication to manage asthma [1,4] and other obstructive airway diseases [6,7]. However, correct inhaler use is often suboptimal in patients with obstructive airway disease, resulting in reduced therapeutic benefit [6,12]. In particular, patients who are older, have underlying pulmonary symptoms, and/or who have received less education and training regarding correct use of their specific device can experience difficulty with achieving correct inhalation technique [12,14,31,32].…”

“…However, correct inhaler use is often suboptimal in patients with obstructive airway disease, resulting in reduced therapeutic benefit [6,12]. In particular, patients who are older, have underlying pulmonary symptoms, and/or who have received less education and training regarding correct use of their specific device can experience difficulty with achieving correct inhalation technique [12,14,31,32]. Good inhaler competence appears to be a contributor to the beneficial outcomes and rates of patient satisfaction achieved with the B/F Easyhaler in the present study of older patients with asthma or COPD.…”

“…The first-choice route of administering medication to manage asthma [1,4] and COPD [6,7] is inhalation. Many types of devices are available for the delivery of inhaled drugs [8]; however, studies have shown that * 32-89% of patients do not use their inhaler correctly [9][10][11][12][13][14]. A similar rate of inhaler technique errors occurs for patients with asthma or COPD [15].…”

Patients’ sensory perception and satisfaction with use of metered dose inhalers and dry powder inhalers in moderate persistent asthma

“…Also use of DPIs does not require careful coordination as in case pMDIs. 16 Another reason for higher satisfaction in DPI users could be less strong taste and hence more liking for the taste of DPI, more amount of drug that is felt reaching the throat, slight moist feeling in throat after inhalation (no dryness) and few adverse effects with the device.…”

“…15 An observational study by Ramadan et al found that higher percentage of DPI users found their device easy to use as compared to pMDIs. 16 Aggarwal et al, conducted a comparative study using pMDIs and DPIs and observed that patients were more satisfied with the use of metered dose inhalers and hence showed better adherence than patients on DPIs. 17 India, particularly Haryana, has poor literacy rate so educating the patients for the proper use of such devices is a real challenge.…”