Satisfaction, preference and error occurrence of three dry powder inhalers as assessed by a cohort naïve to inhaler operation

Abstract

Background

Inhaled medication is central to the treatment of COPD. Various types of inhaler devices, which directly deliver medication to the lung, have been developed. However, patients often exhibit incorrect techniques of inhaler usage. Effectiveness of therapy may be affected by the ease of device usage, size, convenience of use, durability, clarity of instructions and device preferences of patients. This study compares the satisfaction and preference, as well as error occurrence, with the use of Genuair^®, Ellipta™ and Breezhaler™ by healthy subjects in Hong Kong.

Subjects and methods

One hundred and thirty healthy Hong Kong Chinese subjects aged ≥40 years without a previous diagnosis of COPD and asthma and with no experience of using dry powder inhalers (DPIs) were recruited. Subjects learned to use the three DPIs by initially reading the instructions and then observing a demonstration with verbal explanation. The number of errors committed was evaluated. Subjects also completed a questionnaire to indicate their satisfaction and preference.

Results

The satisfaction score of comfort for Breezhaler was significantly higher than that for Ellipta (p≤0.05), while the satisfaction score on confidence to have inhaled the entire dose was highest for Genuair compared with Ellipta (p≤0.0001) or Breezhaler (p≤0.05). The overall satisfaction score was significantly higher for Genuair than Ellipta (p≤0.05) or Breezhaler (p≤0.01). After reading the instructions, the highest number of subjects committing one or more critical errors was with Breezhaler (97) followed by Genuair (70) and then Ellipta (33). Demonstration reduced the number of critical errors made by subjects for each DPI to one third or lower.

Conclusion

Breezhaler seemed to be more comfortable and easy to carry, but users made less critical errors when using Ellipta after reading the instructions only. Genuair provided the clearest indication of correct dose preparation and inhalation.

Keywords:

• chronic obstructive pulmonary disease
• inhalation device
• Genuair^®
• Ellipta™
• Breezhaler™

Supplementary materials

Figure S1 Satisfaction scores on different attributes of the three DPIs as evaluated by male and female subjects.

Notes: Mean values are plotted and the error bars represent the SEM. *p≤0.05; **p≤0.01.

Abbreviations: DPIs, dry powder inhalers; SEM, standard error of the mean.

Figure S2 Satisfaction scores on different attributes of the three DPIs as evaluated by subjects below 60 years of age or above or equal to 60 years of age.

Notes: Mean values are plotted and the error bars represent the SEM. *p≤0.05; **p≤0.01; ***p≤0.001.

Abbreviations: DPIs, dry powder inhalers; SEM, standard error of the mean.

Figure S3 Satisfaction scores on different attributes of the three DPIs by male and female subjects.

Notes: Mean values are plotted and the error bars represent the SEM. No significance was detected.

Abbreviations: DPIs, dry powder inhalers; SEM, standard error of the mean.

Figure S4 Satisfaction scores on different attributes of the three DPIs by subjects <60 and ≥60 years of age.

Notes: Mean values are plotted and the error bars represent the SEM. *p≤0.05.

Abbreviations: DPIs, dry powder inhalers; SEM, standard error of the mean.

Table S1 List of critical and non-critical errors for each dry powder inhaler

Table S2 0.2 SD and 0.5 SD of satisfactory scores of the three DPIs

Table S3 Total number of non-critical errors committed during use of the three DPIs

Acknowledgments

We would like to thank Mr Kwok Yan Ng, University of Hong Kong, School of Biological Sciences for his help in recruiting participants. We appreciate the support from Dr Hiu Fai Law with the statistical analysis of the data.

Disclosure

The authors report no conflicts of interest in this work.