Inhaler Devices in a Geriatric Patient Population: A Prospective Cross-Sectional Study on Patient Preferences

Figures & data

Table 1 Test Results from the Geriatric Assessment of Visual Acuity, Hand Force, Finger Force, and Fine Motor Skills

	N	Mean	SD	Median	Min	Max
Visual acuity with glasses	106	0.460	0.2707	0.500	0.0	1.0
Visual acuity without glasses	106	0.081	0.1908	0.000	0.0	0.7
Hand force left	106	17.0708	8.48475	16.3333	0.00	41.33
Hand force right	106	18.7264	8.33480	18.0833	0.00	40.67
Pinch grip right	106	4.7189	1.93593	4.6500	0.00	11.00
Three-point grip right	106	5.2151	2.06756	5.4000	0.00	10.00
Lateral grip right	106	5.8991	2.11721	5.9500	0.00	10.50
Pinch grip left	106	4.5519	2.05525	4.5000	0.00	9.00
Three-point grip left	106	4.9066	2.05075	5.1500	0.00	9.50
Lateral grip left	106	5.3708	2.15570	5.5000	0.00	11.00
9-Hole Peg Test	106	28.3542	11.85034	24.6150	17.50	113.52

Abbreviations: Max, maximum; Min, minimum; N, number; SD, standard deviation.

Figure 1 Importance of inhaler attributes from the perspective of geriatric patients (N=106). Proportion of patients (%) who gave the respective rating.

Abbreviation: N, patient number.

Figure 2 Number of attempts (mean) that patients needed until the inhaler device was used correctly. The dotted line shows the mean of attempts to error-free use across all 9 devices (2.47). *Nexthaler vs other devices p<0.001.

Abbreviations: SD, standard deviation; vs, versus.

Figure 3 Average number of attempts until the inhaler was used correctly by the patients (N=106) depending on the position within the randomization sequence for device demonstration and testing (A) across all devices, (B) for the Nexthaler. The dotted line shows the mean of attempts to error-free use across all 9 devices (2.47).

Abbreviation: N/n, number of patients.

Figure 4 Positive preference: device that patients (N=106) would choose from amongst the 9 featured inhalers. Proportion of patients (%) who reported a positive preference for the respective device. Each patient was allowed to name only one device preference.

Abbreviation: N/n, patient number.

Figure 5 Negative preference: device that patients (N=106) would least prefer among the 9 inhalers presented. Percentage of patients (%) who reported a negative preference for the respective device. Each patient was allowed to name only one negative preference. * Elpenhaler vs other devices: p<0.001.

Abbreviations: N/n, patient number; vs, versus.

Figure 6 Device-related handling characteristics, assessed by the geriatric patients using “school grades” from 1 to 5. Like the design = I like the design of the device. Easy to learn = It was easy to learn how to use the device. Easy to prepare = It was easy to prepare the device. Comfortable in hand = The device is comfortable when held in my hand. Comfortable mouthpiece = The mouthpiece was comfortable when using the device. Easy to use = It was easy to use the device. Correct use = I felt that I had used the device correctly. Easy in emergency situations = I think it is possible to use the device easily and correctly in emergency situations. *Nexthaler vs other devices p<0.001.

Figure 7 Dependency of positive preference on cognitive status: Comparison of the 3 inhalation devices that performed best, grouped in terms of cognitive status as assessed by MMSE. Spiromax was more frequently mentioned as the preferred device for moderate dementia, Nexthaler more often for mild dementia and Genuair for normal cognition (p=0.004 for the difference in distribution). The dotted lines show the percentage of patients from the entire population (N=106) who were documented in the respective dementia category. Normal cognition = MMSE score of 27; mild dementia = MMSE score of 20–26; moderate dementia = MMSE score of 10–19 points.

Abbreviations: MMSE, Minimal-Mental State Examination; N/n, patient number.