A cross-sectional study to assess inhalation device handling and patient satisfaction in COPD

Figures & data

Table 1 Baseline characteristics of patients

	Respimat^® (n=77)	Breezhaler^® (n=77)	Total (N=154)	P-value
Age – mean (SD)	69.7 (10.0)	67.0 (9.9)	68.4 (10.0)	0.102
Male – n (%)	69 (89.6)	70 (90.9)	139 (90.3)	0.786
BMI – n (%)				0.063
<18 kg/m^2	1 (1.3)	1 (1.3)	2 (1.3)
18 to ≤30 kg/m^2	48 (62.3)	51 (66.2)	99 (64.3)
>30 kg/m^2	27 (35.1)	25 (32.5)	52 (33.8)
Smoking status – n (%)				0.496
Current smoker	18 (23.4)	15 (19.5)	33 (21.4)
Ex-smokers	55 (71.4)	60 (77.9)	115 (74.7)
Pack-years of smoking – mean (SD)	57.9 (26.2)	55.7 (24.7)	56.8 (25.4)	0.605
Time since COPD diagnosis, years – (SD)	6.3 (6.0)	5.9 (5.4)	6.1 (5.7)	0.643
Postbronchodilation spirometry – mean (SD)
FEV1 – liters	1.5 (0.6)	1.6 (0.7)	1.6 (0.6)	0.214
FEV1 – % of predicted value	55.1 (16.5)	56.5 (21.5)	55.8 (19.1)	0.652
FVC – liters	2.8 (0.8)	3.1 (0.9)	3.0 (0.9)	0.035
FVC – % of predicted value	76.2 (16.7)	81.7 (23.4)	78.9 (20.4)	0.098
FEV1/FVC	53.9 (12.9)	51.8 (12.2)	52.9 (12.5)	0.304
Respiratory medication – n (%)
Inhaled anticholinergics
Long-acting
SPIRIVA^® Respimat^®	77 (100)	0 (0.0)	77 (50.0)
Short-acting	8 (10.4)	13 (16.9)	21 (13.6)	0.240
Inhaled β-agonists
Long-acting
Hirobriz^® Breezhaler^®	0 (0.0)	16 (20.8)	16 (10.4)
Onbrez^® Breezhaler^®	0 (0.0)	51 (66.2)	51 (33.1)
Oslif^® Breezhaler^®	0 (0.0)	10 (13.0)	10 (6.5)
Short-acting	46 (59.7)	43 (55.8)	89 (57.8)	0.624
Corticosteroids
Inhaled	52 (67.5)	22 (28.6)	74 (48.1)	<0.001
Systemic	3 (3.9)	3 (3.9)	6 (3.9)	1.000
Theophylline	0 (0.0)	2 (2.6)	2 (1.3)	0.497
Received training on inhalation technique at initial prescription – n (%)	73 (94.8)	76 (98.7)	149 (96.8)	0.367
Instructions given by – n (%)
Doctor	51 (69.9)	42 (55.3)	93 (62.4)
Nurse	18 (24.7)	34 (44.7)	52 (34.9)
Pharmacist	2 (2.7)	0 (0.0)	2 (1.3)
Other	1 (1.4)	0 (0.0)	1 (0.7)
Missing	1 (1.4)	0 (0.0)	1 (0.7)

Note: P-values are based on chi-square test or Fisher’s exact test for the categorical variables, and on a two-sample t-test for the continuous variables.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC₁, forced vital capacity; SD, standard deviation.

Table 2 PASAPQ scores by treatment

PASAPQ scores	Respimat^® (n=77)	Breezhaler^® (n=77)	Mean difference (95% CI)	P-value
Total score	80.7 (10.5)	79.9 (12.7)	0.8 (−2.9 to 4.5)	0.67
Total performance	82.5 (12.6)	78.2 (15.8)	4.3 (−0.3 to 8.9)	0.06
Total convenience	78.6 (11.3)	81.9 (11.7)	−3.3 (−7.0 to 0.4)	0.08
Overall satisfaction	6.0 (0.8)	5.9 (1.2)	0.1 (−0.3 to 0.4)	0.70

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

Abbreviations: CI, confidence interval; PASAPQ, Patient Satisfaction and Preference Questionnaire; SD, standard deviation.

Figure 1 Mean PASAPQ scores by treatment.

Abbreviations: PASAPQ, Patient Satisfaction and Preference Questionnaire; SD, standard deviation.

Figure 2 Distribution of total PASAPQ scores.

Abbreviation: PASAPQ, Patient Satisfaction and Preference Questionnaire.

Table 3 PASAPQ scores stratified by age groups

PASAPQ scores	Age groups		P-value
	≤70 years	>70 years
Total score
Respimat^®	80.1 (12.4)	81.3 (8.2)	0.62
Breezhaler^®	81.8 (11.2)	77.1 (14.4)	0.11
Total performance
Respimat^®	81.0 (15.4)	84.0 (8.7)	0.30
Breezhaler^®	80.7 (13.4)	74.5 (18.5)	0.09
Total convenience
Respimat^®	79.1 (12.7)	78.1 (9.8)	0.72
Breezhaler^®	83.1 (10.8)	80.2 (13.1)	0.29
Overall satisfaction
Respimat^®	6.0 (1.0)	6.0 (0.6)	0.88
Breezhaler^®	6.1 (1.2)	5.6 (1.2)	0.04

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

Abbreviations: PASAPQ, Patient Satisfaction and Preference Questionnaire; SD, standard deviation.

Table 4 PASAPQ scores stratified by smoking status

PASAPQ scores	Smoking status		P-value
	Current smoker	Ex-smoker
Total score
Respimat^®	82.8 (11.5)	79.8 (10.4)	0.30
Breezhaler^®	76.1 (10.7)	80.8 (13.1)	0.20
Total performance
Respimat^®	82.7 (14.1)	82.2 (12.5)	0.89
Breezhaler^®	73.8 (13.7)	79.3 (16.2)	0.23
Total convenience
Respimat^®	83.0 (10.7)	77.1 (11.5)	0.06
Breezhaler^®	78.7 (11.5)	82.5 (11.9)	0.27
Overall satisfaction
Respimat^®	6.2 (0.9)	5.9 (0.8)	0.19
Breezhaler^®	5.3 (1.7)	6.1 (1.0)	0.02

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

Abbreviations: PASAPQ, Patient Satisfaction and Preference Questionnaire; SD, standard deviation.

Table 5 PASAPQ scores stratified by time since diagnosis of COPD

PASAPQ scores	Time since COPD diagnosis		P-value
	≤6 years	>6 years
Total score
Respimat^®	79.6 (12.3)	82.3 (6.9)	0.28
Breezhaler^®	80.0 (12.8)	79.9 (12.7)	0.98
Total performance
Respimat^®	80.5 (14.8)	85.5 (7.6)	0.09
Breezhaler^®	78.2 (15.4)	78.2 (16.8)	0.99
Total convenience
Respimat^®	78.7 (13.0)	78.6 (8.4)	0.98
Breezhaler^®	82.0 (12.3)	81.9 (11.1)	0.96
Overall satisfaction
Respimat^®	5.9 (1.0)	6.0 (0.5)	0.73
Breezhaler^®	5.8 (1.3)	6.0 (1.0)	0.43

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

Abbreviations: COPD, chronic obstructive pulmonary disease; PASAPQ, Patient Satisfaction and Preference Questionnaire; SD, standard deviation.

Table S1 Validated questions included in the modified PASAPQ

Domain	Question	Description
Total score
Performance domain	Q1	Overall feeling of inhaling
	Q2	Inhaled dose goes to lungs
	Q3	Amount of medication left
	Q4	Works reliably
	Q5	Ease of inhaling a dose
	Q10	Using the inhaler
	Q11	Speed medicine comes out
Convenience domain	Q6	Instructions for use
	Q7	Size of inhaler
	Q8	Durability of inhaler
	Q9	Ease of cleaning inhaler
	Q12	Ease of holding during use
	Q13	Convenience of carrying
	Q14	Overall satisfaction

Notes: All items scored on a 7-point Likert scale: 1= very dissatisfied, 2= dissatisfied, 3= somewhat dissatisfied, 4= neither satisfied nor dissatisfied, 5= somewhat satisfied, 6= satisfied, 7= very satisfied.

Abbreviation: PASAPQ, Patient Satisfaction and Preference Questionnaire.