Journal Article

A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices

Zhu, Chang-Qing, Chrystyn, Henry, Thomas, Mike, Goosens, Martijn, van der Valk, Paul DLPM, Stonham, Carol, Imber, Varsha, Sharma, Raj K, van der Palen, Job, Svedsater, Henrik, Wilkinson, Tom, Barnes, Neil C, Chauhan, Anoop J

2016

Overview

Errors in the use of different inhalers were investigated in patients naive to the devices under investigation in a multicentre, single-visit, randomised, open-label, cross-over study. Patients with chronic obstructive pulmonary disease (COPD) or asthma were assigned to ELLIPTA vs DISKUS (Accuhaler), metered-dose inhaler (MDI) or Turbuhaler. Patients with COPD were also assigned to ELLIPTA vs Handihaler or Breezhaler. Patients demonstrated inhaler use after reading the patient information leaflet (PIL). A trained investigator assessed critical errors (i.e., those likely to result in the inhalation of significantly reduced, minimal or no medication). If the patient made errors, the investigator demonstrated the correct use of the inhaler, and the patient demonstrated inhaler use again. Fewer COPD patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS, 9/171 (5%) vs 75/171 (44%); MDI, 10/80 (13%) vs 48/80 (60%); Turbuhaler, 8/100 (8%) vs 44/100 (44%); Handihaler, 17/118 (14%) vs 57/118 (48%); Breezhaler, 13/98 (13%) vs 45/98 (46%; all P <0.001). Most patients (57–70%) made no errors using ELLIPTA and did not require investigator instruction. Instruction was required for DISKUS (65%), MDI (85%), Turbuhaler (71%), Handihaler (62%) and Breezhaler (56%). Fewer asthma patients made critical errors with ELLIPTA after reading the PIL vs: DISKUS (3/70 (4%) vs 9/70 (13%), P =0.221); MDI (2/32 (6%) vs 8/32 (25%), P =0.074) and significantly fewer vs Turbuhaler (3/60 (5%) vs 20/60 (33%), P <0.001). More asthma and COPD patients preferred ELLIPTA over the other devices (all P ⩽0.002). Significantly, fewer COPD patients using ELLIPTA made critical errors after reading the PIL vs other inhalers. More asthma and COPD patients preferred ELLIPTA over comparator inhalers. Lung disease and asthma: Encouraging effective inhaler use Patients should be coached in inhaler technique by trained professionals to eliminate critical errors. Job van der Palen at the University of Twente, with scientists from across The Netherlands and the UK, tested whether 729 patients with asthma and chronic obstructive pulmonary disease (COPD) could use various inhalers correctly after reading accompanying instructions. A trained professional observed the patients and corrected critical errors before allowing patients to try the inhalers again. More COPD patients displayed errors in inhaler technique compared with asthma sufferers. The ELLIPTA inhaler proved far easier for patients to use from the outset, meaning they made fewer (if any) critical errors. Both asthma and COPD sufferers preferred the ELLIPTA inhaler to the other inhalers tested. The team emphasize the importance of training in correct inhaler use alongside careful selection of inhaler design.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/308/2779 / 692/308/409 / Administration, Inhalation / Adrenal Cortex Hormones - administration & dosage / Adult / Aged / Anti-Asthmatic Agents - administration & dosage / Asthma - drug therapy / Cross-Over Studies / Dry Powder Inhalers / Equipment Design / Female / Humans / Internal Medicine / Male / Medicine / Medicine & Public Health / Metered Dose Inhalers / Middle Aged / Nebulizers and Vaporizers / Pneumology/Respiratory System / Primary Care Medicine / Pulmonary Disease, Chronic Obstructive - drug therapy / Thoracic Surgery