Patient preferences for inhaler devices in chronic obstructive pulmonary disease: experience with Respimat^® Soft Mist^™ Inhaler

Figures & data

Table 1 Factors affecting patients’ attitudes to COPD therapy and their preferences for a specific inhaler device^12–17

Disease and drug factors

Progressive nature of COPD (declining benefit)

Concerns about regular medication, including side effects

Potential side-effects of treatment

Perceived drug efficacy (symptom relief/prevention of exacerbations)

Device factors

Perceived device efficacy

Ease of use of device Need for actuation/inhalation coordination Ability to actuate device (strength, arthritis issues) Ability to generate sufficient inspiratory flows (dry powder inhalers)

Convenience of device Dose and refill frequency Dose counter Availability of combination inhalers

Feelings of stigmatization due to need for device use in public

Physician device preference

Availability of drug/device preparations

“Brand loyalty”

Cost

Time to learn; clear instructions

Size, weight, taste, device appearance

Cleaning issues

Disposability/environmental issues

Table 2 Items and scoring for the patient satisfaction and preference questionnaire (PASAPQ)^44,45

Domain		Question	Description	Scoring
Total score	Performance domain	Q1	Overall feeling of inhaling	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
		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
Stand alone questions		Q14	Overall satisfaction
		Preference		○ Prefer inhaler 1 ○ Prefer Inhaler 2 ○ No preference
		Willingness to continue		Each inhaler given a score between 0 and 100

Table 3 Summary of study methods and outcomes of non-comparative trials of Respimat^® Soft Mist^™ Inhaler (SMI) that assessed patient satisfaction

Devices compared	Disease	Trial duration	Number of patients	Type of study and drug delivered	Assessment tool	Outcome	Reference or company study code
Respimat^® SMI alone	COPD	12 weeks	47	Post-clinical trial questionnaire; either ipratropium + fenoterol or placebo	10-point Likert rating scale: 1 (extremely dissatisfied) to 10 (extremely satisfied)	Ratings of 9 or 10 given by 64% of patients	Boehringer Ingelheim (215.1349)
Respimat^® SMI alone	COPD	26 weeks	129	Post-clinical trial questionnaire; either ipratropium or placebo	10-point Likert rating scale: 1 (extremely dissatisfied) to 10 (extremely satisfied)	Ratings of 9 or 10 given by 74% of patients	Boehringer Ingelheim (244.2484)
Respimat^® SMI alone	COPD and asthma	4 weeks	4602	Observational study, open-label; ipratropium + fenoterol	5-point rating scale: unsatisfactory to very good	Good or very good ratings from 88.7% of patients for handling, 93% for ease of use	Ref ^Citation46 Boehringer Ingelheim (215.1362)
Respimat^® SMI alone	COPD and asthma	12 weeks	2006	Observational study, open-label; ipratropium + fenoterol	5-point rating scale: very unsatisfied to very satisfied	86.3% patients “satisfied” or “very satisfied” with respimat^® SMI	Ref ^Citation47 Boehringer Ingelheim (215.1363)

Table 4 Summary of study methods and satisfaction outcomes of trials that compared Respimat^® Soft Mist^™ Inhaler (SMI) with another inhaler device using a validated assessment tool (Patient Satisfaction and Preference Questionnaire; PASAPQ) to assess satisfaction scores

Devices compared	Disease	Trial duration	Number of patients	Type of study and drug delivered	Satisfaction outcome (mean total PASAPQ scores)	Reference or company study code
Respimat^® SMI vs HFA pMDI	COPD and asthma	7 + 7 weeks	224	Crossover study, open-label; ipratropium + fenoterol	Respimat^® SMI, 83.7; pMDI, 72.9; mean difference, 10.8 (SD, 20.3); P < 0.001	Ref ^Citation27 Boehringer Ingelheim (215.1357)
Respimat^® SMI vs DPI (Turbuhaler)	Asthma	12 weeks	153	Post-clinical trial questionnaire, double-dummy design; budesonide or placebo	Respimat^® SMI, 85.5 (SD, 13.5) Turbuhaler^®, 76.9 (16.3), mean difference, 8.6; P < 0.0001 for difference)	Ref ^Citation48 Boehringer Ingelheim (1047.16)
Respimat^® SMI vs DPI (Diskus)	COPD and asthma	4 weeks	150	Observational study, open-label; ipratropium + fenoterol (Respimat^® SMI); corticosteroid + LABA (Diskus^®)	Respimat^® SMI, 80.2; Diskus^®, 75.5; mean difference, 4.7; P = 0.001	Ref ^Citation49 Boehringer Ingelheim (215.1366)

Abbreviations: CFC, chlorofluorocarbon; DPI, dry powder inhaler; HFA, hydrofluoroalkane; LABA, long-acting beta-agonist; pMDI, pressurized metered dose inhaler; SD, standard deviation.

Figure 1 Proportion of patients indicating preference for Respimat^® Soft Mist^™ Inhaler (SMI) or an alternative inhaler device in 3 studies that used the Patient Satisfaction and Preference Questionnaire (PASAPQ): A) Pressurized metered-dose inhaler (pMDI) in a clinical study (n = 224);²⁷ B) Turbuhaler^® in a clinical study (n = 153);⁴⁸ C) Diskus^® in an observational study (n = 150).⁴⁹

Figure 2 Mean PASAPQ satisfaction scores for Respimat^® SMI compared with A) Turbuhaler^® in a clinical study⁴⁸ and B) Diskus^® in an observational study.⁴⁹ Total scores and performance and convenience domain scores are transformed to a scale of 0 to 100 points; P values for differences between devices are from general linear models analysis (Turbuhaler^®) and paired t-test (Diskus^®).

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