Genuair^®/Pressair^® Inhaler in COPD: The Patient Perspective

Figures & data

Table 1. Characteristics of available DPIs for delivering COPD medications (16, 18, 44–49).

	Genuair (16)	Handihaler (44)	Breezhaler (45)	Accuhaler/Diskus (46)	Ellipta (47)	NEXThaler (48)	Turbohaler (49)
DPI type	Multidose	Single dose	Single dose	Multidose	Multidose	Multidose	Multidose
Number of steps required for use according to IFU^a	4	11	10	5	4	3	5
Feedback if device is ready to use	Yes	No	No	No	No	No	No
Dose counter/indicator	Indicator	Not required	Not required	Counter	Counter	Counter	Indicator
Overdose prevention mechanism	Yes	Not required	Not required	Yes	Yes	No	Yes
Feedback on correct inhalation	Yes	Partial^b	Partial^c	No	No	Partial^d	No
Lock-out mechanism if empty	Yes	Not required	Not required	No	No	No	No
Need to clean	No	Yes	Yes	No	No	No	Yes
Inspiratory flow rate at 4.0 kPa pressure (L/min) (18)	64	37	111	72	74	54	54

^a Includes removing and replacing protective cap.

^b Hearing or feeling the vibration of capsule only.

^c Whirring noise as the capsule spins around the chamber.

^d May notice a taste or feel a click.

COPD = chronic obstructive pulmonary disease; DPI = dry-powder inhaler; IFU = instructions for use.

Figure 1. Relationships between (a) patient-rated inhaler satisfaction and physician-assessed treatment compliance, and between compliance and (b) exacerbations, and (c) hospitalizations due to exacerbations in COPD patients (12). COPD = chronic obstructive pulmonary disease. Reprinted from (12) Copyright 2014, with permission from Elsevier.

Figure 2. PIF through the Genuair^® and HandiHaler^® inhalers in patients with moderate or severe COPD (19). Data points above the line reflect greater PIF through the Genuair^® inhaler versus the HandiHaler^®. COPD = chronic obstructive pulmonary disease; PIF = peak inspiratory flow. Reprinted from (19) Copyright 2009, with permission from Elsevier.

Figure 3. Structure and mechanism of the cyclone unit of the Genuair^® device. Effective particle deagglomeration and powder aerosol generation is provided by the cyclone unit; (a) shows the position of the cyclone unit inside the Genuair^® mouthpiece (transparent view); (b) shows the cyclone base (b1), powder channel (b2), and front (b3) and back (b4) view of the cyclone unit; (c) shows particle activities in the cyclone after an inhalation time of ∼0.25 s.

Figure 4. Genuair inhalation process (16). Step 1: after removing the cap, the patient must hold the inhaler horizontally and press the button all the way down to load the dose. The control window will then change from red to green to indicate that the medicine is ready to be inhaled. The button can then be released. Step 2: after breathing out thoroughly, the patient must take a strong, deep breath through the mouthpiece to actuate the dose. The control window will change to red, indicating the medicine has been inhaled correctly.

Figure 5. Cost per patient (mean ± standard deviation) of the time spent by the nurse explaining inhaler operability (33). COPD = chronic obstructive pulmonary disease. Republished with permission of Dove Medical Press, from The economic impact of educational training assessed by the Handling Questionnaire with three inhalation devices in asthma and Chronic Obstructive Pulmonary Disease patients. Dal Negro R, Povero M. ClinicoEconomics and Outcomes Research 2016;8:171–176.

Figure 6. Overall inhaler device preference in two open-label, crossover studies (35, 36) and one double-blind, double-dummy study (39) comparing device performance in patients with COPD. ***p < 0.001; ****p < 0.0001. COPD = chronic obstructive pulmonary disease.

Table 2. Patient satisfaction and willingness to continue with Genuair^® compared with other inhalation devices: results from randomized crossover studies (34–37, 39).

	Van der Palen et al. (35)	Pascual et al. (36)	Vogelmeier et al. (39)	Ohbayashi et al. (34)	Man et al. (37)
Patient population	Moderate to severe, stable COPD (n = 105)	COPD and moderate to severe airflow obstruction (n = 110)	Moderate to severe, stable COPD (n = 933)	COPD (n = 54)	Healthy subjects without a previous COPD or asthma diagnosis and no experience using DPIs (n = 130)
Devices assessed	Placebo from Genuair^® and Handihaler^® in addition to current COPD medication	Placebo from Genuair^® and Breezhaler^® in addition to current COPD medication	Aclidinium/formoterol 400/12 µg twice daily via Genuair^® plus placebo via Accuhaler OR Salmeterol/fluticasone 50/500 µg twice daily via Accuhaler plus placebo via Genuair^®	Aclidinium bromide 400 µg twice daily via Genuair^® and tiotropium 5 µg once daily via Respimat^®	Placebo from Genuair^® and Ellipta^® and empty capsules from Breezhaler^®
Key results
Patient satisfaction
Assessment scale	1 = very dissatisfied; 5 = very satisfied	1 = very dissatisfied; 7 = very satisfied	NA	1 = best response; 5 = worst response	NA
Mean score	Genuair^®: 4.6 Handihaler^®: 3.8	Genuair^®: 5.9 Breezhaler^®: 5.3	NA	Genuair^®: 2.2 Respimat^®: 2.6	NA
p value^a	p < 0.0001	p < 0.001		p < 0.001
Willingness to continue
Assessment scale	0 = not willing; 100 = definitely willing	0 = not willing; 100 = definitely willing	0 = not willing; 100 = definitely willing	1 = best response; 5 = worst response	0 = not willing; 100 = definitely willing
Mean score	Genuair^®: 84.0 Handihaler^®: 62.5	Genuair^®: 79.6 Breezhaler^®: 63.6	Genuair^®: 78.6 Accuhaler: 64.3	Genuair^®: 2.5 Respimat^®: 2.9	Genuair^®: 78.8 Ellipta^®: 73.2 Breezhaler^®: 71.0
p value^a	p < 0.0001	p < 0.0001	p < 0.0001	p = 0.005	p = 0.0132 (vs Ellipta^®) p= 0.0063 (vs Breezhaler^®)

^a In favor of Genuair^®.

COPD = chronic obstructive pulmonary disease; DPI = dry powder inhaler; NA = not assessed.

Figure 7. Response to the question “which device offers the most convenience in terms of…?”: the patient’s opinion (32). CI = confidence interval. Reproduced from (32) Creative Commons Attribution 4.0 International License. For licence, please see http://creativecommons.org/licenses/by/4.0/

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