Maintenance inhaler preference, attribute importance, and satisfaction in prescribing physicians and patients with asthma, COPD, or asthma–COPD overlap syndrome consulting for routine care

Figures & data

Figure 1 Inhaler attributes as reported by patients by diagnosis (extremely satisfied).

Abbreviation: ACOS, asthma–COPD overlap syndrome.

Table 1 Type of inhaler prescribed for maintenance therapy by respiratory condition

	Asthma, % (n)	COPD, % (n)	ACOS, % (n)
Number of inhaled maintenance medications
Mean (95% CI)	1.1 (1.1, 1.1)	1.5 (1.5, 1.6)	1.5 (1.5, 1.6)
Drug device type – patient level (multi-response)
DPI	62.8 (2,346)	88.5 (2,943)	84.0 (204)
MDI	35.3 (1,320)	18.9 (628)	27.2 (66)
SMI	0.4 (15)	4.4 (145)	3.3 (8)
baMDI	1.5 (56)	0.9 (29)	1.2 (3)
Unknown device	4.5 (167)	4.7 (155)	7 (17)
Totala	104.5 (3,904)	117.3 (3,900)	122.6 (298)

Note:

a Total >100% as some patients used more than one inhaler type for maintenance therapy.

Abbreviations: ACOS, asthma–COPD overlap syndrome; baMDI, breath-actuated metered dose inhaler; DPI, dry powder inhaler; MDI, metered dose inhaler; SMI, soft mist inhaler.

Figure 2 Inhaler preference of PCP, pulm, and allergist (asthma-only).

Abbreviations: ACOS, asthma–COPD overlap syndrome; MDI, metered dose inhaler; PCP, primary care physician; pulm, pulmonologist; SMI, soft mist inhaler.

Table 2 Top five inhaler attributes as reported by patients by condition

	Asthma, % (n) [rank]	COPD, % (n) [rank]	ACOS, % (n) [rank]
The instructions are simple and easy to follow	54.6 (808) [1st]	60.9 (393) [1st]	52.6 (20) [1st]
It is built to last and will not break easily	27.5 (407) [5th]	34.7 (224) [2nd]	29.0 (11) [2nd]
Easy to hold and carry around with me	33.3 (493) [2nd]	29.2 (188) [4th]	23.7 (9) [3rd]
No need for me to put the medicine into the inhaler before I use it	31.4 (465) [3rd]	25.3 (163) [5th]	[Not in top 5]
I do not need to breathe in hard to inhale my medicine	[Not in top 5]	[Not in top 5]	23.7 (9) [3rd]
I get the same amount of medicine delivered to my lungs each time	28.2 (417) [4th]	29.3 (189) [3rd]	[Not in top 5]
It tells me how many doses of my medicine I have left	[Not in top 5]	[Not in top 5]	21.1 (8) [5th]

Abbreviation: ACOS, asthma–COPD overlap syndrome.

Table 3 Effect of patient characteristics by whether suitability of inhaler is a reason for physician choice

	Ease of use/suitability of inhaler device is		P-value between groups
	NOT a reason for choice	A reason for choice
Asthma	n=1,939	n=1,014
Patient age, mean (95% CI)a	42.4 (41.7, 43.2)	44.4 (43.3, 45.5)	0.0088
Months since diagnosis, mean (95% CI)b	82 (76.8, 87.0)	102.5 (94.0, 111.1)	<0.0001
Current physician-reported severity of patients’ asthma, %c
Intermittent	25.2	26.4	0.9579
Mild persistent	40.9	38.1
Moderate persistent	29.0	31.3
Severe persistent	4.9	4.2
COPD	n=1,861	n=911
Patient age, mean (95% CI)	65.4 (64.9, 65.9)	66.5 (65.8, 67.1)	0.0068
Months since diagnosis, mean (95% CI)d	59.8 (56.7, 62.9)	66.5 (61.6, 71.5)	0.0252
Current physician-reported severity of patients’ COPD, %
Mild	17.8	15.2	0.0002
Moderate	54.6	49.2
Severe	20.2	27.3
Very severe	7.5	8.3
CAT score, mean (95% CI)e	20.1 (19.5, 20.6)	21.3 (20.5, 22.1)	0.0147
mMRC dyspnea scale, %f
0	22.0	18.9	0.0341
1	40.0	36.6
2	20.8	24.5
3	11.8	14.6
4	5.3	5.4
Post-bronchodilator FEV^Citation1, % predicted (95% CI)g	62.1 (61.0, 63.3)	61.1 (59.3, 62.9)	0.406
ACOS	n=121	n=61
Patient age, mean (95% CI)	64.4 (62.6, 66.2)	65.9 (62.9, 68.9)	0.2686
Months since diagnosis, mean (95% CI)h	70.3 (53.9, 86.8)	72.0 (54.4, 89.6)	0.2807
Current physician-reported severity of patients’ ACOS, %
Mild	15.7	15.3	0.777
Moderate	52.1	55.9
Severe	27.3	23.7
Very severe	5.0	5.1

Notes:

a n=1,938, 1,013;

b n=1,608, 838;

c n=1,909, 1,005;

d n=1,599, 770;

e n=841, 434;

f n=862, 424;

g n=831, 399;

h n=96, 57.

Abbreviations: ACOS, asthma–COPD overlap syndrome; CAT, COPD assessment test; FEV₁, forced expiratory volume in 1 second; mMRC, modified Medical Research Council.

Global Initiative for Chronic Obstructive Lung DiseaseGlobal Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) [updated 2015] Available from: http://www.ginasthma.org/Accessed June 16, 2016

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