Assessment of satisfaction with different dry powder inhalation devices in Greek patients with COPD and asthma: the ANASA study

Figures & data

Table 1 Characteristics of all patients with asthma and COPD and distribution according to disease severity and inhaler device

	Diskus^®	Elpenhaler^®	Turbuhaler^®	Total	P-value
Asthma
Number of patients recruited	173	163	224	560	0.09
Number of patients lost in follow-up	10	11	16	37	0.18
Number of patients who completed the study	163	152	208	523	0.07
Sex, n					0.53
Male	67	51	73	191
Female	98	101	135	332
Age (years)	51.6 (15.6)	49.9 (16.3)	49.5 (16.2)	50.3 (16.1)	0.42
Disease duration (years)	23.7 (15)	22.9 (16.5)	21.5 (14)	22.5 (15.1)	0.23
Time in DPI (months)	11.9 (9.8)	12.6 (10.2)	12.3 (10.1)	12.3 (10.3)	0.81
Height (cm)	166.1 (9.2)	167.1 (10.9)	166.5 (8.9)	166.6 (9.6)	0.67
BMI (kg/m^2)	28.6 (5.3)	27.9 (6.9)	27.3 (5.9)	27.9 (5.9)	0.10
Smoking status (%)					0.54
Current smokers	16.4	20.3	13.7	16.4
Ex-smokers	19.9	20.3	22.9	21.2
Never smokers	63.7	59.5	63.4	62.4
Disease severity, n					0.62
Mild	43	47	60	150
Moderate	97	86	126	308
Severe	23	20	22	65
FEV1 (lt)	2.45 (0.98)	2.39 (0.89)	2.44 (0.85)	2.43 (0.9)	0.78
FEV1 (% of predicted)	84.3 (20.9)	82.2 (19.5)	84.3 (19.5)	83.7 (20)	0.58
FEV1/FVC	76.8 (15.3)	80.7 (10.4)	77.9 (13.3)	79.0 (13.3)	0.12
COPD
Number of patients recruited	201	208	152	561	0.07
Number of patients lost in follow-up	16	16	12	44	0.14
Number of patients who completed the study	185	192	140	517	0.09
Sex, n					0.10
Male	136	144	117	397
Female	49	48	23	120
Age (years)	66.5 (9.0)	66 (10.8)	65.9 (10.7)	66.1 (10.2)	0.85
Disease duration (years)	7.7 (5.5)	7.9 (6.5)	7.5 (5.4)	7.6 (5.8)	0.73
Time in DPI (months)	10.9 (8.8)	11.6 (9.2)	11.4 (8.1)	11.3 (8.8)	0.51
Height (cm)	167.6 (8.4)	168.1 (8.4)	168.8 (8.2)	168.1 (8.4)	0.43
BMI (kg/m^2)	28.4 (5)	28.4 (5.2)	28.1 (6.1)	28.3 (5.4)	0.79
Smoking status (%)					0.83
Current smokers	35.8	34.5	33.6	34.7
Ex-smokers	54.7	58.9	58.7	57.4
Never smokers	9.5	6.6	7.7	7.9
Disease severity, n					0.74
Stage I	30	31	21	82
Stage II	82	100	67	249
Stage III	61	52	40	153
Stage IV	12	9	12	33
FEV1 (lt)	1.64 (0.70)	1.72 (0.65)	1.65 (0.67)	1.67 (0.68)	0.42
FEV1 (% of predicted)	61.2 (12.3)	64.1 (11.5)	59.6 (11.1)	61.8 (11.7)	0.14
FEV1/FVC	59.1 (6.8)	58.6 (4.8)	54.8 (6.7)	57.2 (6.1)	0.09

Note: Data are presented as mean (SD) unless otherwise specified.

Abbreviations: DPI, dry powder inhaler; BMI, body mass index; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; SD, standard deviation.

Table 2 The FSI-10 interitem correlation matrix

	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10
Q1	1	0.648	0.640	0.403	0.373	0.400	0.414	0.281	0.458	0.550
Q2	0.648	1	0.628	0.403	0.393	0.305	0.411	0.301	0.335	0.503
Q3	0.640	0.628	1	0.473	0.499	0.470	0.472	0.362	0.513	0.615
Q4	0.403	0.403	0.473	1	0.478	0.474	0.447	0.370	0.443	0.513
Q5	0.373	0.393	0.499	0.478	1	0.498	0.597	0.516	0.452	0.582
Q6	0.400	0.305	0.470	0.474	0.498	1	0.507	0.405	0.529	0.572
Q7	0.414	0.411	0.472	0.447	0.597	0.507	1	0.634	0.442	0.592
Q8	0.281	0.301	0.362	0.370	0.516	0.405	0.634	1	0.322	0.478
Q9	0.458	0.335	0.513	0.443	0.452	0.529	0.442	0.322	1	0.666
Q10	0.550	0.503	0.615	0.513	0.582	0.572	0.592	0.478	0.666	1

Abbreviations: FSI-10, Feeling of Satisfaction with Inhaler; Q, question.

Table 3 The FSI-10 questions score differences and the corresponding P-values between the different inhaler devices in patients with asthma and COPD

	Hardly at all (1)			Not very (2)			Somewhat (3)			Fairly (4)			Very (5)			Mean FSI-10			P-value	Post hoc comparison
	DK	EH	TH	DK	EH	TH	DK	EH	TH	DK	EH	TH	DK	EH	TH	DK	EH	TH		EH versus DK	EH versus TH	TH versus DK
Asthma
Q1	0.6	0	0.5	1.8	3.3	1	14	5.2	13.2	44.4	40.5	47.8	39.2	51	37.6	4.20	4.39	4.21	ns	–	–	–
Q2	0	0.7	0.5	1.2	3.3	1.5	10.5	11.8	11.7	45.6	41.2	42	42.7	43.1	44.4	4.30	4.23	4.28	ns	–	–	–
Q3	0	1.3	0	1.8	0.7	1.5	12.9	7.2	9.8	38.6	27.5	42.4	46.8	63.4	46.3	4.30	4.51	4.34	<0.05	<0.05	<0.05	ns
Q4	0.6	0	0	2.9	0.7	2.9	16.4	4.6	10.2	40.4	28.1	36.1	39.8	66.7	50.7	4.16	4.61	4.35	<0.001	<0.001	<0.01	ns
Q5	0.6	0	0	3.5	2	0.5	15.2	10.5	8.8	43.3	32	42.4	37.4	55.6	48.3	4.13	4.41	4.39	<0.05	<0.05	ns	<0.05
Q6	0	0	1	4.1	0	0.5	12.3	3.9	7.3	38.6	29.4	34.6	45	66.7	56.6	4.25	4.63	4.45	<0.001	<0.001	ns	<0.05
Q7	0	0	0	4.7	2	0.5	15.8	11.1	9.3	40.9	38.6	34.1	38.6	48.4	56.1	4.13	4.39	4.46	<0.05	ns	ns	<0.01
Q8	1.2	1.3	0	5.8	4.6	0.5	26.3	15	11.2	37.4	39.9	34.1	29.2	39.2	54.1	3.88	4.11	4.42	<0.001	ns	<0.01	<0.001
Q9	0.6	0.7	1.5	5.3	1.3	9.8	21.6	7.2	22.4	42.7	27.5	40.5	29.8	63.4	25.9	3.96	4.52	3.80	<0.001	<0.001	<0.001	ns
Q10	0	1.3	0	2.3	0.7	0.5	13.5	5.9	8.8	53.8	41.2	51.7	30.4	51	39	4.12	4.40	4.29	<0.05	<0.01	ns	ns
COPD
Q1	0	0	0	6.3	2	4.9	14.2	12.7	21.7	41.1	39.6	44.1	38.4	45.7	29.4	4.12	4.29	3.98	<0.05	ns	<0.01	ns
Q2	0	0	0	3.2	3	2.1	12.6	14.7	18.2	45.8	37.6	45.5	38.4	44.7	34.3	4.24	4.19	4.12	ns	–	–	–
Q3	0	0.5	0	2.6	0.5	3.5	12.6	7.1	13.3	38.4	30.5	46.9	46.3	61.4	36.4	4.28	4.52	4.16	<0.01	<0.05	<0.01	ns
Q4	1.1	0	0.7	8.4	1	2.1	18.4	4.1	14.7	33.7	35.5	39.2	38.4	59.4	43.4	4	4.53	4.22	<0.001	<0.001	<0.01	ns
Q5	1.1	0.5	0.7	4.2	1	0.7	14.7	6.1	9.8	41.1	32.5	49.7	38.9	59.9	39.2	4.13	4.50	4.26	<0.001	<0.001	<0.01	ns
6Q	0.5	0	1.4	6.8	0.5	2.1	13.2	2	8.4	39.5	18.8	43.4	40	78.7	44.8	4.12	4.76	4.28	<0.001	<0.001	<0.001	ns
Q7	1.1	0.5	0	8.9	0.5	1.4	17.4	8.1	9.8	32.1	36.5	45.5	40.5	54.3	43.4	4.02	4.44	4.31	<0.001	<0.001	ns	<0.05
Q8	2.8	1	0	8.4	3	1.4	18.4	9.6	14	32.1	38.1	39.9	38.4	48.2	44.8	3.95	4.28	4.30	<0.001	<0.01	ns	<0.01
Q9	1.1	0	2.8	6.8	1.5	7	20.5	4.6	25.9	42.6	24.9	41.3	28.9	69	23.1	3.92	4.61	3.75	<0.001	<0.001	<0.001	ns
Q10	0	0	0	6.3	1	3.5	11.6	3.6	12.6	52.6	41.1	53.8	29.5	54.3	30.1	4.05	4.49	4.10	<0.001	<0.001	<0.001	ns

Notes: Higher mean FSI-10 scores are designated in bold. Data are presented as mean percentage. The values (numbers) in the parenthesis in the column headings are the numeric score of the five possible answers of each question of FSI-10 questionnaire.

Abbreviations: FSI-10, Feeling of Satisfaction with Inhaler; DK, Diskus^®; EH, Elpenhaler^®; TH, Turbuhaler^®; ns, not significant.

Figure 1 Estimated differences in the mean total score of the FSI-10 questionnaire in 523 asthma patients between the examined inhalers (A), according to the age category of the patients (B), and the asthma severity stage (C) for every inhaler studied.

Abbreviations: FSI-10, Feeling of Satisfaction with Inhaler; FSI, Feeling of Satisfaction.

Figure 2 Estimated differences in the mean total score of the FSI-10 questionnaire in 517 COPD patients, between the examined inhalers (A), according to the age category of the patients (B), and the COPD severity stage (C) for every inhaler studied.

Abbreviations: FSI-10, Feeling of Satisfaction with Inhaler; FSI, Feeling of Satisfaction.

Table

The Feeling of Satisfaction with Inhaler (FSI-10 questionnaire)
How would you score the inhalation device you have used in the last week on the following points? Choose only 1 response, the one that best reflects your opinion. There are no right or wrong answers. We simply want to know your opinion on certain features of the inhaler. Please answer honestly and do not leave any questions unanswered.
1. Has it been easy to learn how to use the inhaler?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
2. Was it easy to prepare the inhaler for use?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
3. Was it easy to use the inhaler?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
4. Was it easy to keep the inhaler clean and in good working condition?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
5. Was it easy to continue normal activities with the use of the inhaler?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
6. Did the inhaler fit your lips comfortably?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
7. Was using the inhaler easy in terms of size and weight?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
8. Was it easy to carry the inhaler with you?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
9. After you’ve used the inhaler, do you have the feeling that you used it correctly?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all
10. Overall, considering your responses to the previous questions, were you satisfied with the inhaler?
□ Very	□ Fairly	□ Somewhat	□ Not very	□ Hardly at all