Questionnaire on switching from the tiotropium HandiHaler to the Respimat inhaler in patients with chronic obstructive pulmonary disease: changes in handling and preferences immediately and several years after the switch

Abstract

Background Tiotropium (Spiriva) is an inhaled muscarinic antagonist for patients with chronic obstructive pulmonary disease (COPD), and is available in two forms: the HandiHaler and the Respimat inhaler. The aim of this study was to investigate the handling of and preference for each device immediately after switching from the HandiHaler to the Respimat and 2–3 years after the switch. Materials and methods The study comprised two surveys. A questionnaire was first administered to 57 patients with COPD (male:female 52:5, mean age 73.6±7.1 years) 8 weeks after switching from the HandiHaler (18 μg) to the Respimat (5 μg). A second similar but simplified questionnaire was administered to 39 of these patients who continued to use the Respimat and were available for follow-up after more than 2 years. Pulmonary function was also measured during each period. Results In the first survey, 17.5% of patients preferred the HandiHaler, and 45.6% preferred the Respimat. There were no significant changes in pulmonary function or in the incidence of adverse events after the switch. In the second survey, performed 2–3 years later, the self-assessed handling of the Respimat had significantly improved, and the number of patients who preferred the Respimat had increased to 79.5%. Conclusion The efficacy of the Respimat was similar to that of the HandiHaler. This was clear immediately after the switch, even in elderly patients with COPD who were long-term users of the HandiHaler. The preference for the Respimat increased with continued use.

Patients’ perspectives and preferences in the choice of inhalers: the case for Respimat^®or HandiHaler^®

“…In a follow-up study, 2–3 years later, the proportion of patients who expressed a preference for Respimat ® had significantly increased to 80% ( P <0.0001) 55. The different responses obtained during the first and second surveys may suggest that the change in inhaler device was stressful for the patients.…”

“…One survey of patients with COPD suggested that Respimat ® had a significantly milder aftertaste than HandiHaler ® , but there were no significant differences between the incidence of surveyed adverse events, including dry mouth and throat-related side effects 55. In another survey, Respimat ® was associated with increased incidence of cough within the first 4 weeks of switching from HandiHaler ® ; however, this was transient and most patients overcame having a cough as they got used to using Respimat ® 41…”

“…In a survey of patients with COPD that evaluated their handling experiences and preferences 8 weeks after switching from tiotropium HandiHaler ® to Respimat ® , 46% of patients stated that they preferred Respimat ® 55. In a follow-up study, 2–3 years later, the proportion of patients who expressed a preference for Respimat ® had significantly increased to 80% ( P <0.0001) 55.…”

Bronchodilator efficacy of 18 &micro;g once-daily tiotropium inhalation via Discair^&reg; versus HandiHaler^&reg; in adults with chronic obstructive pulmonary disease: randomized, active-controlled, parallel-group, open-label, Phase IV trial

“…Some of the disadvantages of the HandiHaler are: a) the need to place an individual capsule into the device immediately before each use, b) the need to discard the spent capsule and to clean the device and remove remnants of the hard gelatin capsule after each use, c) potential hygiene problems from the need to repeat the loading and cleaning steps, and d) difficulty of using the device by patients with impaired dexterity 19,28. Another disadvantage is that a patient’s inspiratory effort affects powder dispersion, and the operational complexity of the device can make it challenging to generate sufficient fine particles to ensure proper drug deposition in the lower airway in the elderly and patients with more severe airway obstruction 28,30.…”

“…Given the rise of error rates in use of inhalation devices with increasing age,35 easy-to-use multidose DPIs are considered as especially beneficial for elderly COPD patients because they can improve patient adherence to treatment and thereby improve long-term outcome 19,36…”