Shared Decision-Making Facilitates Inhaler Choice in Patients with Newly-Diagnosed Chronic Obstructive Pulmonary Disease: A Multicenter Prospective Study

Abstract

Purpose

Inadequate inhaler technique and nonadherence to therapy are associated with poorer clinical outcomes in chronic obstructive pulmonary disease (COPD). Shared decision-making (SDM), based on clinical evidence, patient goals and preferences, improves quality of care. This study aims to investigate the initial patients’ choices of inhaler devices in patients with newly-diagnosed COPD after an SDM process.

Patients and Methods

We conducted a prospective, observational, multi-center study in four hospitals in Taiwan from December 2019 to July 2021. All treatment-naïve patients with newly-diagnosed COPD who were able to use three different inhalers of dual bronchodilators (Respimat^®, Ellipta^®, and Breezhaler^®) in the outpatient setting were enrolled. After an SDM process, every patient was prescribed with one inhaler chosen by him- or herself. Errors of using inhalers were recorded after prescription of the inhaler, and at the follow-up visit a month later. The patients’ adherence, satisfaction score, and willingness to keep the initially chosen inhaler were investigated.

Results

In 109 enrolled patients, 43, 45, and 21 patients chose Respimat^®, Ellipta^®, and Breezhaler^®, respectively. Patients chose different inhalers had similar rates of critical error on both visits, while the rates greatly decrease on the follow-up visit, no matter which inhaler devices they chose initially. The majority of patients had good adherence (use as the prescription daily, n = 79, 82%), satisfaction (satisfaction score ≥4, n = 70, 73%), and strong willingness to keep the initial inhaler (n = 89, 93%) on the follow-up visit regardless of disease severity and their comorbidities.

Conclusion

SDM might facilitate inhaler choosing, reduce inhaler errors (versus baseline) with good adherence, satisfaction and strong willingness to keep the initial inhaler in patients with newly-diagnosed COPD.

Keywords:

• shared decision-making
• inhaler choice
• dual bronchodilators
• chronic obstructive pulmonary disease

Abbreviations

aORs, Adjusted odds ratios; CAT, COPD assessment test; CI, Confidence intervals; COPD, Chronic obstructive pulmonary disease; FDC, Fixed-dose combination; GOLD, Global Initiative for Obstructive Lung Disease; IQR, Interquartile ranges; LABA, Long-acting β2 agonists; LAMA, Long-acting muscarinic antagonists; mMRC, Modified medical research council; ORs, Odds ratios; SDM, Shared decision-making.

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Taipei Veterans General Hospital (VGHTPE-IRB No. 2019-08-009BC), Cheng-Hsin General Hospital (CHGH-IRB (711)108B-27), National Taiwan University Hospital Yunlin Branch (201907106RINC), and Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20190252). Written informed consent was obtained from all subjects involved in the study.

Acknowledgments

The authors would like to thank all patients and educators, Ying-Ju Lin, Chun-Mei Chiu, Min-Shan Yeh, and Shiao-Yun Wu, participating in this study, James Pang from BalDr Strategic Consulting (Hong Kong) Ltd. Taiwan Branch, and Dr. Jen-Yu Hung and Tse-Kuang Kai from Kaohsiung Medical University Hospital for their assistance.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

C.C.S. has received speaker fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis and Pfizer, and has acted as an investigator for trials sponsored by AstraZeneca, Novartis, Roche, Sanofi-Regeneron, Galapagos, Shionogi, Aridis, Bristol Myers Squibb, Insmed and Horizon Therapeutics. H.Y.W has received honorariums for lectures from Boehringer Ingelheim, GlaxoSmithKline, Novartis and AstraZeneca. All other authors have received honorariums for lectures from Boehringer Ingelheim, GlaxoSmithKline, Novartis, AstraZeneca, and Orient EuroPharma. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research was partially funded by grants from the Ministry of Science and Technology, Taiwan (MOST-109-2314-B-075-065 to Y.H.H. and MOST-108-2314-B-037-097-MY3 to M.J.T.), Taipei Veterans General Hospital (V111B-013 to Y.H.H.), and Kaohsiung Medical University Hospital (KMUH110-0R16 and KMUH-DK(B)11003-3 to M.J.T.). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.