Questionnaire on switching from the tiotropium HandiHaler to the Respimat inhaler in patients with chronic obstructive pulmonary disease: changes in handling and preferences immediately and several years after the switch

Figures & data

Table 1 Patient characteristics

	First surveya	Second survey
n	57	39
Age (years)	73.6±7.1 (53–87)	73.1±7.3
Sex (male:female)	52:5	37:2
Body mass index (kg/m^2)	21.0±2.6	20.7±2.7
Peak inspiratory flow (L/min)
Without adaptor	175.8±67.8 (50–327)	176.5±61.2 (60–327)
With adaptor (HH)	44.1±8.8 (30–65)	43.8±7.9 (30–65)
VC (%)	96.3±21.4	96.7±19.1
FVC (%)	94.6±22.3	95.6±20.6
FEV1/FVC (%)	46.4±10.7	44.4±10.0
Predicted % FEV1 (%)	64.0±24.4	61.8±24.2
Severity of airflow limitation (%)
GOLD 1: mild	9.6	8.6
GOLD 2: moderate	44.2	42.9
GOLD 3: severe	36.5	37.1
GOLD 4: very severe	9.6	11.4
Long-term oxygen therapy (%)	12 (21.1)	9 (23.1)
Asthma complications (%)	8 (14.0)	2 (5.1)
Duration of HandiHaler use
<1 year	8	4
≥1 year	49	35
Duration between the surveys	NA	933±51 (735–1,072)

Notes:

a The first survey was administered 8 weeks after patients switched from the HandiHaler to the Respimat, and the second survey was administered 2–3 years after patients continued Respimat treatment. Data presented as the mean ± standard deviation (range) unless otherwise indicated.

Abbreviations: n, number of patients; HH, HandiHaler; VC, vital capacity; FVC, forced vital capacity; FEV₁, forced expiratory volume in one second; NA, not applicable; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 1 Initial questionnaire on usage, effectiveness, inhalation technique, and overall satisfaction 8 weeks after switching from the HandiHaler to the Respimat inhaler.

Notes: Question 1, Do you think that you can use Spiriva well? Question 2: What do you think about the effect of Spiriva on shortness of breath or dyspnea? Question 3: Please tell us about any difficulties you experienced when using each inhaler as follows: Q3–1, on inhalation technique; Q3–2, on breath-holding technique; Q3–3, on overall handling or usability. Question 5: Please tell us your overall satisfaction with Spiriva for each inhaler. The inhalation technique required for Respimat was significantly more difficult than that required for the HandiHaler (P=0.049, question 3–1), but there was no significant difference in the usage (question 1), perceived effect of the medication (question 2), breath-holding technique (question 3–2), or overall handling (question 3–3). Evaluations of the Respimat were classified as “good” or “bad” (question 5), but no significant difference was detected between the devices.

Figure 2 Questionnaire on adverse events 8 weeks after switching from the HandiHaler inhaler to the Respimat inhaler.

Notes: Respimat had a significantly milder aftertaste than the HandiHaler (P=0.004), but there were no other significant differences in the incidence of adverse events (question 4: Please indicate whether you experienced any of the following symptoms after using each device).

Figure 3 Comparison of patient preference for the HandiHaler and Respimat.

Note: A total 45.6% of patients preferred the Respimat compared with 17.5% who preferred the HandiHaler (question 6: Which inhaler do you prefer?).

Table 2 Pulmonary function before and after switching from the HandiHaler to the Respimat

N=24	Before Respimat treatment	After Respimat treatment	P-value
VC (L)	3.01±0.68	3.10±0.60	0.018
IC (L)	2.01±0.60	2.05±0.55	0.218
FVC (L)	2.99±0.69	3.07±0.61	0.108
FEV1 (L)	1.39±0.55	1.43±0.59	0.195
V50	0.57±0.41	0.61±0.44	0.095
V25	0.18±0.08	0.19±0.09	0.180
V50/V25	2.95±1.27	2.93±1.10	0.396

Notes: Data presented as the mean ± standard deviation. Significance at P<0.05.

Abbreviations: VC, vital capacity; IC, inspiratory capacity; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; V₅₀, expiratory flow at 50% of vital capacity; V₂₅, expiratory flow at 25% of vital capacity.

Figure 4 The second questionnaire administered 2–3 years after switching from the HandiHaler to the Respimat, and comparison of responses to those in the first survey.

Notes: Question 1: Do you think that you can use Spiriva well? Question 3: Please tell us about any difficulties you experienced when using each inhaler, as follows: Q3–2, on breath-holding technique; Q3–3, on overall handling or usability. Question 5: Please give us your overall satisfaction with Spiriva for each device. The usage (question 1), perceived breath-hold technique (question 3–2), overall handling (question 3–3), and overall satisfaction (question 5) with Respimat were significantly improved compared to the results of the first survey (P=0.0008, P=0.0017, P=0.031, and P=0.0086, respectively). The overall satisfaction with the HandiHaler was significantly worse in the second survey (P=0.0436, question 5).

Figure 5 Changes in preference for Respimat between the first and second surveys.

Note: The preference for Respimat significantly increased at the second survey (question 6: Which inhaler do you prefer? [P<0.0001]).

Figure 6 Annual decline in FEV₁ in patients classified according to the change in overall satisfaction with each device.

Notes: A greater improvement in overall satisfaction was associated with a lower decline in FEV₁, although the differences between the three groups were not significant. Data are presented as the mean ± standard deviation.
Abbreviation: ∆FEV₁, decline in forced expiratory volume in 1 second.