The Impact of a Forced Non-Medical Switch of Inhaled Respiratory Medication Among Patients with Asthma or Chronic Obstructive Pulmonary Disease: A Patient Survey on Experience with Switch, Therapy Satisfaction, and Disease Control

Figures & data

Table 1 Patient Survey Components

Category	Cohorts	Assessments
Patient Satisfaction & Preference Questionnaire (PASAPQ) Direct Comparison Version^Citation17	Asthma COPD	Measures respiratory inhalation device satisfaction and preference
Onset of Effect Questionnaire (OEQ)^Citation18	Asthma COPD	Measures patient perception of how quickly maintenance medications begin to work
Asthma Control Questionnaire-6 (ACQ-6)^Citation19	Asthma	Measures the adequacy of asthma control
COPD Assessment Test™ (CAT)^Citation21	COPD	Measures the health status of patients with COPD
Other custom, stand-alone questions	Asthma COPD	Reliever bronchodilator use for COPD Patient demographics Communication and training of the new inhaler Date of the first puff of the new inhaler Treatment satisfaction, convenience, preference

Abbreviation: COPD, chronic obstructive pulmonary disease.

Table 2 Patient Characteristics

Category	Patients (%) (N=100)
Age group^a
45–64 years	9
65–74 years	63
75–84 years	24
≥85 years	4
Gender
Male	56
Education
Less than high school	4
High school graduate^b	48
Associate’s degree	18
College graduate	30
Employment status
Retired	72
Employed full time	11
Other	17
Smoking status
Current smoker	19
Ex-smoker	52
Non-smoker	29
Time from first diagnosis to survey date
<1 year ago	2
1‒5 years ago	47
>5 years ago	51
DPI ICS/LABA to which patients switched
BID DPI (fluticasone propionate/salmeterol)
100/50 mcg	14
250/50 mcg	17
500/50 mcg	22
QD DPI (fluticasone furoate/vilanterol)
100/25 mcg	25
200/25 mcg	22
Time from the switch prescription date to the survey date (months)
Mean (SD)	7 (2)
Median (IQR)	7 (5‒9)
Min–Max	1–11

Notes: ^aAge response options included “18–34 years old” and “35–44 years old;” no patients reported to be aged <45 years. ^bn=19 patients with a high school degree also reported “some college” education.

Abbreviations: BID, twice daily; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; ICS, inhaled corticosteroid; IQR, interquartile range; LABA, long-acting β₂-agonist; QD, once daily; SD, standard deviation.

Table 3 Patients’ Responses on Communication and Training of the New Therapy

Patients’ Experience with the Switch^a	Patients (%) (N=100)
Communication of the switch to the patient (not mutually exclusive)
Either physician or nurse practitioner	93
Physician	75
Nurse practitioner	29
At pharmacy	16
Training received for the new inhaler (not mutually exclusive)
A health care provider either actually demonstrated how to use it or watched me use the medicine and instructed me on how to use it	73
A health care provider actually demonstrated how to use it	58
A health care provider watched me use the medicine and instructed me on how to use it	46
I was given written instructions from a health care provider	41
I watched a video	24
Mobile applications (mobile phone/tablets)	14
I read the package insert	10

Notes: ^aResults shown only for survey responses that >10% of patients selected. Patients were allowed to select multiple response options.

Figure 1 Patient PASAPQ scores.^a Overall satisfaction and domain PASAPQ scores for the asthma, COPD, BID DPI, and QD DPI cohorts.

Note: ^aThe total PASAPQ score ranges from 0 (least satisfied) to 100 (most satisfied), based on the Performance and Convenience domain scores, which range from 0 (least satisfied) to 100 (most satisfied). The Overall Satisfaction score is based on a stand-alone question, ranging from 1 (very dissatisfied) to 7 (very satisfied).

Abbreviations: BID, twice daily; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; PASAPQ, Patient Satisfaction & Preference Questionnaire; QD, once daily.

Figure 2 Patient responses to OEQ.^a Percentages of patients from each cohort who agreed or disagreed with primary items in the OEQ. (A) Responses to “During the past week, you could feel your controller medication begin to work right away” and (B) responses to “During the past week, you were satisfied with how quickly you felt your controller medication begin to work.”

Note: ^aTwo primary items from the OEQ are shown.

Abbreviations: BID, twice daily; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; OEQ, Onset of Effect Questionnaire; QD, once daily.

Figure 3 Patient responses to stand-alone medication satisfaction questions.^a Percentages of patients from each cohort who reported each satisfaction level with their medication. (A) Responses to “How satisfied or dissatisfied are you with the ability of the medication to prevent or treat your asthma/COPD?” and (B) responses to “How satisfied or dissatisfied are you by how often you are expected to use/take the medication?”

Notes: ^aResponse options included “Extremely dissatisfied”; no patients selected this option.

Abbreviations: BID, twice daily; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; QD, once daily.

Table 4 Disease Control After Switching to New DPI

Asthma
ACQ-6 score^a	All (n=50)	BID DPI (n=26)	QD DPI (n=24)
Mean (SD)	1.8 (0.9)	1.7 (0.9)	1.8 (0.9)
Median	1.8	1.8	1.9
COPD
CAT score^b	All (n=50)	BID DPI (n=27)	QD DPI (n=23)
Mean (SD)	21.9 (7.1)	22.1 (6.5)	21.7 (8.0)
Median	22.5	23.0	22.0

Notes: ^aACQ-6 scores range from 0 to 7, with higher scores indicating asthma that is less controlled. ^bCAT scores range from 0 to 40, with higher scores denoting a more severe impact of COPD on a patient’s life.

Abbreviations: ACQ-6, Asthma Control Questionnaire-6; BID, twice daily; CAT, COPD Assessment Test™; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; QD, once daily; SD, standard deviation.

Figure 4 Disease control level after switching to the new DPI. (A) Asthma symptom control^a and (B) COPD disease impact scores on patients’ lives^b by cohort and dosing frequency.

Notes: ^aACQ-6 scores range from 0 to 7, with higher scores indicating asthma that is less controlled. ^bCAT scores range from 0 to 40, with higher scores indicating more severe impact of COPD on a patient’s life.

Abbreviations: ACQ-6, Asthma Control Questionnaire-6; BID, twice daily; CAT, COPD Assessment Test™; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; QD, once daily.

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