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

ABSTRACT

Background: Many patients do not use inhalers correctly. Inhalers associated with good technique have the potential to improve symptom control and are often preferred by patients. Methods: Inhaler-naïve, adult volunteers were randomized to use empty Spiromax®, Easyhaler®, and Turbuhaler® dry powder inhalers (DPIs) in one of six possible sequences in this single-site, single-visit, crossover study conducted in Sweden. Randomization was stratified by age and gender. Participants attempted to use each device intuitively (no instructions) and after reading the instructions for use from the patient information leaflet. Device preference was surveyed after using all devices. Mastery of device handling (i.e. dose preparation) or inhalation was defined as having no healthcare-professional-observed errors. The primary endpoint was mastery of device handling after reading the instructions. Results: More participants mastered device handling with Spiromax vs Easyhaler or Turbuhaler, both intuitively (44%, 0%, and 10%, respectively) and after reading the instructions (99%, 56%, and 81%, respectively). Fewer participants had ≥1 device-handling error with Spiromax than with the other devices. The percentage of participants still showing inhalation errors after reading the instructions ranged between 21% for Spiromax and 40% for Easyhaler. After reading instructions, mastery of handling and inhalation was numerically lower among older (aged >60 years) vs younger participants across all devices. Most participants preferred Spiromax for device handling (59%) and intuitiveness/ease of use (61%). Conclusion: These findings highlight that important differences exist between DPI devices, which could have implications for disease control when selecting a device for a patient.

KEYWORDS:

• Dry powder inhaler
• asthma
• COPD
• inhalation drug administration
• inhalation therapy
• medication adherence

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Acknowledgments

Medical writing support was provided by Jo Swainston, PhD, and Victoria A. Robb, PhD, of GeoMed, an Ashfield company, part of UDG Healthcare plc, and was funded by Teva Europe. Teva provided a full review of the article. The authors were fully responsible for all content and editorial decisions, were involved at all stages of manuscript development, and have approved the final version.

Disclosure of interest

PR has given lectures at events sponsored by Teva Pharmaceuticals. BR has received remuneration for the audit of studies. GS is an employee of Teva Pharmaceuticals. SM has declared no conflicts of interest. LJ has attended advisory boards and given lectures at events sponsored by Teva Pharmaceuticals.

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Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was sponsored by Teva Sweden AB. Medical writing support was funded by Teva Europe.

Notes on contributors

Per Rönmark

Per Rönmark is a general practitioner at the Primary Health Care Center of Stadsfjärden, Praktikertjänst in Nyköping, Sweden. He is specialist in family medicine since 1994 and has a special interest in asthma and COPD in primary care.

Guilherme Safioti

Guilherme Safioti, MD, is a specialist in Respiratory Medicine, Global Medical Director for Connected Respiratory, Teva Pharmaceuticals, Amsterdam in the Netherlands. His research focus is inhalation therapy, digital interventions and predictive analytics in asthma and COPD.

Leif Bjermer

Leif Bjermer, MD, PhD, is a Professor in Pulmonary Medicine and Allergology at Skåne University Hospital, Lund University in Sweden. He is Head of Respiratory Medicine and Allergology, Department of Clinical Sciences in Lund. His primary research area is airway pathophysiology, including immunopharmacological research in patients with asthma and COPD. He runs a clinical trial unit mainly doing phase II and III studies in patients with asthma or COPD and is responsible for the regional competence centre for Asthma, Allergy and COPD.