Are outcomes the same with all dry powder inhalers? (original) (raw)
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Asthma patient satisfaction with different dry powder inhalers
Expert Review of Respiratory Medicine, 2019
Background: The preferences and opinions of patients are important when choosing the optimal inhaler device for asthma management. We compared patient satisfaction of three dry powder inhalers in patients with moderate to severe asthma. Methods: We selected a group of patients treated with Easyhaler TM (n = 164) and a second group of patients treated with Turbuhaler TM (n = 100) or Diskus TM (Accuhaler TM) (n = 64) from the register of an observational, multicenter study. Data of patients were paired according to age, gender, and asthma severity. Patient satisfaction with the inhaler type was assessed with the specific 'Feeling of Satisfaction with Inhaler' (FSI-10) questionnaire. Results: Specific satisfaction with inhaler was statistically significantly higher with Easyhaler TM , as well as the percentage of patients with high satisfaction with inhaler. (FSI-10 score ≥43). Scores for Easyhaler TM were also statistically significantly better for individual FSI-10 items such as learning how to use, inhaler preparation, inhaler use, weight and size, and portability. There were no significant differences in asthma control (ACT, Mini-AQLQ) and adherence (TAI global score). Conclusions: Specific satisfaction with inhaler was higher with Easyhaler TM in a homogeneous population of patients with moderate to severe asthma. However, the relationship between satisfaction with the inhaler and adherence and asthma control deserves more investigation.
Journal of Asthma and Allergy, 2011
Results of randomized controlled trials may not predict effectiveness of inhaled corticosteroids (ICS) in real-world clinical practice, where inhaler technique and device characteristics can influence effectiveness. We compared asthma outcomes for ICS delivered via three different inhaler devices: pressurized metered-dose inhaler (pMDI), breath-actuated MDI (BAI), and dry powder inhaler (DPI). Patients and methods: This retrospective database study evaluated 1-year outcomes for primary care patients with asthma aged 5-60 years prescribed their first ICS (initiation population) by pMDI (n = 39,746), BAI (n = 9809), or DPI (n = 6792), or their first ICS dose increase (step-up population) by pMDI (n = 6245), BAI (n = 1388), or DPI (n = 1536). Co-primary outcome measures were composite proxy measures of asthma control (no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory infection) and severe exacerbations (unscheduled hospital admission, emergency room attendance, or oral corticosteroids). Outcomes were adjusted for potential confounding factors identified during a baseline year. Results: In the initiation population, adjusted odds ratios (95% confidence intervals [CI]) for asthma control, as compared with pMDIs, were significantly better for BAIs (1.08 [1.02-1.14]) and DPIs (1.13 [1.06-1.21]), while adjusted exacerbation rate ratios (95% CI) were 1.00 (0.93-1.08) and 0.88 (0.81-0.95), respectively. In the step-up population, adjusted odds of asthma control were 1.21 (1.05-1.39) for BAIs and 1.13 (0.99-1.29) for DPIs; adjusted exacerbation rate ratios were 0.83 (0.71-0.98) for BAIs and 0.85 (0.74-0.98) for DPIs, compared with pMDIs. Conclusion: Inhaler device selection may have a bearing on clinical outcomes. Differences in real-world effectiveness among these devices require closer evaluation in well-designed prospective trials.
Understanding Dry Powder Inhalers: Key Technical and Patient Preference Attributes
Advances in Therapy
Inhalable medications for patients with asthma and chronic obstructive pulmonary disease (COPD) can be confusing even for health care professionals because of the multitude of available devices each with different operating principles. Dry powder inhalers (DPI) are a valuable option for almost all of the patients with asthma or COPD. Based on recorded patient inspiratory profiles, the peak inspiratory flow requirement of 30 L min-1 of high-resistance devices does not usually pose any practical limitations for the patients. Suboptimal adherence and errors in device handling are common and require continuous checking and patient education in order to avoid these pitfalls of all inhalation therapy. The aim of this opinion paper is to describe the working principles of DPIs and to summarise their key properties in order to help prescribing the correct inhaler for each patient.
[Patient preference in the choice of dry powder inhalers]
2004
OBJECTIVE: To investigate a group of patients' preferences among 3 dry powder inhalers-Accuhaler ® , Easyhaler ® , and Turbuhaler ®-and to analyze the features that were most important for motivating choices. MATERIAL AND METHOD: The study enrolled 30 patients with stable asthma with a mean (SD) age of 40 (13) and who habitually used inhaled corticosteroids. The patients were shown in detail how to use each of the devices and were randomized to begin using them in different orders. After using each inhaler for a week, the patients assessed 9 different features on a scale of 0 to 10 with an independent observer. The patients were asked to put the inhalers in order of preference, and finally to demonstrate they could use them correctly. RESULTS: All patients correctly performed the inhalation maneuver at the beginning and the end of the study. The mean final scores out of 90 of the 9 features evaluated were 75 (13) for the Easyhaler, 67 (12) for the Accuhaler, and 65 (14) for the Turbuhaler. Differences were statistically significant between the first and the second device (P=0.02) and the first and the third (P=.001) but not between the Accuhaler and the Turbuhaler (P=.376). Mean rating scores were 8.6 (1.4) for the Easyhaler, 7.3 (1.9) for the Turbuhaler, and 7.1 (1.6) for the Accuhaler. The Easyhaler was the first choice for 53% of patients, the Turbuhaler for 27%, and the Accuhaler for 20%. CONCLUSIONS: The Easyhaler was rated the highest by the patients in the study. The scores were a long way from the maximum score, so research into developing an ideal inhaler must continue.
Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler
Respiratory care, 2005
Topically inhaled bronchodilators and corticosteroids are the mainstay of treatment for asthma and chronic obstructive pulmonary disease. These medications are delivered via jet or ultrasonic nebulizer, metered-dose inhaler (MDI), or dry powder inhaler (DPI). While the number of devices may be confusing to patients and clinicians, each device has distinct advantages and disadvantages. Most clinical evidence shows that any of these devices will work for most situations, including exacerbations and in the stable outpatient setting. There is a high rate of errors in device use with all these devices, especially the MDI. In choosing a drug/device combination for a patient, the clinician must take into account several factors, including the cognitive and physical ability of the patient, ease of use, convenience, costs, and patient preferences. Clinicians should also have a rudimentary understanding of aerosol principles in order to be able to teach appropriate use of aerosol devices to t...
Choosing inhaler devices for people with asthma: Current knowledge and outstanding research needs
Respiratory Medicine, 2010
Recommendations in asthma guidelines presuppose that practitioners have the evidence, information, knowledge, and tools to select inhaler devices appropriate for individual patients. Randomised controlled trials usually exclude patients with suboptimal inhaler technique. There is therefore little evidence on which to base inhaler selection in the real world, where patients often use their inhalers incorrectly. The lung deposition of inhaled drug varies according to inhaler device, drug particle size, inhalation technique, and pattern of inspiratory flow. Even with training, not all patients can use their inhalers correctly and maintain inhaler technique; patients may have inability to handle the inhaler, strong negative preferences, or natural breathing patterns that do not match their prescribed inhaler. Therefore, matching device to the patient may be a better course of action than increasing therapy or training and retraining a patient to use a specific inhaler device. Several research questions require answers to meet the goal of helping prescribers make a more informed choice of inhaler type. Is the level of drug deposition in the lungs a key determinant of clinical short-and long-term outcomes? What should be measured by a clinical tool designed to check inhaler technique and therefore help with device selection? If we have a tool to help in individualising inhaler choice, will we achieve better asthma outcomes? Do we have to refine inhaler device choice for each individual, or will we get better outcomes if we select our current best option in light of current knowledge and apply this on a population level? Ó
Compliance with fixed combination vs. separates in patients using dry powder inhalers
Primary Care Respiratory Journal, 2008
Introduction: Inhaled corticosteroids (ICS) are safe and effective treatment for childhood asthma at standard doses, but cross sectional studies suggest that some children are treated with excessively high doses so are at risk of serious adverse effects. We aimed to quantify longitudinal trends in asthma prescribing for children, with particular reference to high dose ICS prescribing. Methods: Retrospective, cross sectional, observational study of general practitioner prescribing for asthma medications in children aged under 12 years with a recorded asthma diagnosis between 1992 and 2004 using the General Practice Research Database (GPRD). Results: Data were available for an average of 357, 956 children per year. The percentage of children prescribed ICS increased from 2.7% in 1992 to 7.0% in 1997 and 1998 and then fell to 3.3% in 2004. In the under 5 year-olds with asthma, high dose ICS prescriptions (>400 mcg/day) fell from 10.6% of all ICS prescriptions in 1992 to 4.5% by 2004. In contrast, high dose ICS prescriptions (>800 mcg/day) for asthmatic 5-11 year-olds rose from 1.1% in 1992 to 4.6% in 2004. Oral corticosteroid prescribing in under 5 year olds asthmatics prescribed ICS fell from 37.1% in 1992 to 21.7% 1999 and remained constant thereafter; the respective percentages for 5-11 year olds were 20.1% and 12.4%. Conclusions: Trends for prescribing in childhood asthma changed dramatically and there are several plausible reasons for this. Off licence high dose ICS prescribing increased in 5-11 year olds and this trend needs urgent attention. 2. Does the burden of allergic rhinitis amongst primary care practitioners impact on patient management?
Assessment of key influences on asthma inhaler device selection
Nursing Standard, 2009
ASTHMA IS A chronic, inflammatory disease of the airways, which results in widespread but variable airflow obstruction in response to a variety of stimuli (National Heart, Lung, and Blood Institute and National Institutes of Health 1992). The principal treatment for patients with asthma is to reduce inflammation by inhalation of medication to the site of the disease process. This can be achieved through the use of various medications and device types (Brocklebank et al 2001). However, despite the availability of these treatments, asthma remains a poorly controlled disease, resulting in a significant burden for patients and the healthcare system (Horne et al 2007). Poor control of asthma can be attributed to risk factors, such as cigarette smoke and co-morbidity, for example allergic rhinitis. Patient behaviour is also key. Evidence shows that successful control of asthma relies on patients' concordance with prescribed inhaled therapies (Wallace et al 2006), and that patients' failure to use medication as prescribed is associated with an increase in asthma-related adverse effects (Jones et al 2003). Despite evidence supporting the role of patient concordance in asthma control, it has been estimated that concordance rates for inhaler use are between 20% and 73% (Cochrane et al 2000). There is debate surrounding the many factors that can affect concordance, but it is accepted that patients are less likely to be concordant if they are unable to use their inhaler (Crompton 2004). Patients have different requirements from their inhaler and therefore no single device will satisfy the needs of all (Dolovich et al 2005). Each type of inhaler has advantages and disadvantages. For example metered dose inhalers are quick to use and portable, but they can be difficult to use because coordination is needed to press the canister and inhale at the same time. Dry powder inhalers are easier to use because they are
Use of dry powder inhalers in acute exacerbations of asthma and COPD
Therapeutic Advances in Respiratory Disease, 2009
This review concluded that dry powder inhalers functioned equally as well as established therapies with other inhaler devices in patients with acute asthma or chronic obstructive pulmonary disease. Given poor reporting of the review process and uncertainty over the quality of the included studies, the authors' conclusions should be interpreted with caution. Authors' objectives To assess the efficacy of dry powder inhalers compared with established therapies delivered by pressurised metered dose inhalers (pMDI) or nebulizers in treatment of acute asthma and chronic obstructive pulmonary disease (COPD), irrespective of rapid-acting β 2-agonist used. Searching MEDLINE, EMBASE, BIOSIS Previews, Current Contents and an internal AstraZeneca database (Planet) were searched for publications or congress abstracts to April 2008; search terms were reported. Reference lists were searched to identify additional articles. Study selection Clinical trials that evaluated rapid-acting β 2-agonists in patients with asthma or COPD treated at emergency departments or hospitals that assessed exacerbation severity (measured as forced expiratory volume (FEV 1) percentage of predicted normal) were eligible for inclusion; included studies comprised randomised studies, open-label studies and investigational (methacholine challenge) studies that compared dry powder inhalers with other delivery devices. Treatments in the included studies included administration of fast-acting β2-agonists (terbutaline, salbutamol, formoterol, budesonide) via dry powder inhalers, most of which were Turbuhaler; these were compared with pMDIs (terbutaline, salbutamol) or nebulizers (terbutaline); one comparison additionally compared placebo. Studies that assessed salmeterol were excluded. Outcomes included improvements in lung function variously measured at different time points (up to 24 hours). Included studies were undertaken in adults and children (ages, where specified, ranged from six to 93 years). Where stated, baseline FEV 1 ranged from 11% to 100% of predicted normal.