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Published in: Current Allergy and Asthma Reports 11/2022

Open Access 10-09-2022 | Bronchial Asthma | Asthma (V Ortega, Section Editor)

Narrative Review of the Role of Patient-Reported Outcomes and Inhaler Handling Errors in the Control of Asthma and COPD

Authors: Raúl De Simón Gutiérrez, Raúl Piedra Castro

Published in: Current Allergy and Asthma Reports | Issue 11/2022

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Abstract

Purpose of Review

Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases that remain uncontrolled in many patients, despite the wide range of therapeutic options available. This review analyzes the available clinical evidence on 3 budesonide/formoterol DPI devices, Spiromax®, Turbuhaler®, and Easyhaler®, in terms of patient-reported outcomes (PROs), inhaler errors, and asthma and COPD control.

Recent Findings

The effectiveness of dry powder inhalers (DPI) depends largely on the device and the patient’s inhaler technique. Equally important are the patient’s perception of the inhaler and adherence. Given the high burden of these diseases, it is important that efforts be made to select the best DPI for each patient and to analyze the impact of these variables to help improve the health and quality of life of our patients.

Summary

This review provides a comprehensive overview of the present knowledge about PROs, inhaler handling errors, and asthma and COPD control achieved by Spiromax®, Turbuhaler®, and Easyhaler®.
Literature
4.
go back to reference Chrystyn H, Lavorini F. The dry powder inhaler features of the Easyhaler that benefit the management of patients. Expert Rev Respir Med. 2020;14(4):345–51.CrossRef Chrystyn H, Lavorini F. The dry powder inhaler features of the Easyhaler that benefit the management of patients. Expert Rev Respir Med. 2020;14(4):345–51.CrossRef
5.
go back to reference Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan JHY, et al. Predictive value of control of COPD for risk of exacerbations: an international, prospective study. Respirology. 2020;25(11):1136–43.CrossRef Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan JHY, et al. Predictive value of control of COPD for risk of exacerbations: an international, prospective study. Respirology. 2020;25(11):1136–43.CrossRef
6.
go back to reference Price D, Fletcher M, Van Der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24. Price D, Fletcher M, Van Der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24.
7.
go back to reference Levy ML, Carroll W, Izquierdo Alonso JL, Keller C, Lavorini F, et al. Understanding dry powder inhalers: key technical and patient preference attributes. Adv Ther. 2019;36(10):2547–57.CrossRef Levy ML, Carroll W, Izquierdo Alonso JL, Keller C, Lavorini F, et al. Understanding dry powder inhalers: key technical and patient preference attributes. Adv Ther. 2019;36(10):2547–57.CrossRef
8.
go back to reference AL-Jahdali H, Ahmed A, AL-Harbi A, Khan M, Baharoon S, Bin Salih S, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy Asthma Clin Immunol. 2013;9(1). AL-Jahdali H, Ahmed A, AL-Harbi A, Khan M, Baharoon S, Bin Salih S, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy Asthma Clin Immunol. 2013;9(1).
9.
go back to reference Crompton GK, Barnes PJ, Broeders M, Corrigan C, Corbetta L, Dekhuijzen R, et al. The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team. Respir Med. 2006;100(9):1479–94.CrossRef Crompton GK, Barnes PJ, Broeders M, Corrigan C, Corbetta L, Dekhuijzen R, et al. The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team. Respir Med. 2006;100(9):1479–94.CrossRef
10.
go back to reference Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481–90.CrossRef Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481–90.CrossRef
11.
go back to reference Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–8.CrossRef Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–8.CrossRef
12.
go back to reference Gregoriano C, Dieterle T, Breitenstein AL, Dürr S, Baum A, Maier S, et al. Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial. Respir Res. 2018;19(1):1–15.CrossRef Gregoriano C, Dieterle T, Breitenstein AL, Dürr S, Baum A, Maier S, et al. Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial. Respir Res. 2018;19(1):1–15.CrossRef
14.
go back to reference Canonica GW, Arp J, Keegstra JR, Chrystyn H. Spiromax, a new dry powder inhaler: dose consistency under simulated real-world conditions. J Aerosol Med Pulm Drug Deliv. 2015;28(5):309–19.CrossRef Canonica GW, Arp J, Keegstra JR, Chrystyn H. Spiromax, a new dry powder inhaler: dose consistency under simulated real-world conditions. J Aerosol Med Pulm Drug Deliv. 2015;28(5):309–19.CrossRef
15.
go back to reference Giner J, Villarnovo Cerrillo M, Aboín Sierra J, Casas Herrero L, Patino O, Plaza V. Assessment of inhalation errors, training time and patient preference for DuoResp® Spiromax® and Symbicort® Turbuhaler® in patients with asthma and COPD. Eur Clin Respir J. 2021;8(1). Giner J, Villarnovo Cerrillo M, Aboín Sierra J, Casas Herrero L, Patino O, Plaza V. Assessment of inhalation errors, training time and patient preference for DuoResp® Spiromax® and Symbicort® Turbuhaler® in patients with asthma and COPD. Eur Clin Respir J. 2021;8(1).
16.
go back to reference Chrystyn H, Safioti G, Keegstra JR, Gopalan G. Effect of inhalation profile and throat geometry on predicted lung deposition of budesonide and formoterol (BF) in COPD: an in-vitro comparison of Spiromax with Turbuhaler. Int J Pharm. 2015;491(1–2):268–76.CrossRef Chrystyn H, Safioti G, Keegstra JR, Gopalan G. Effect of inhalation profile and throat geometry on predicted lung deposition of budesonide and formoterol (BF) in COPD: an in-vitro comparison of Spiromax with Turbuhaler. Int J Pharm. 2015;491(1–2):268–76.CrossRef
17.
go back to reference Atkins PJ. Dry powder inhalers: an overview - PubMed. Respir Care. 2005;50:1304–12.PubMed Atkins PJ. Dry powder inhalers: an overview - PubMed. Respir Care. 2005;50:1304–12.PubMed
19.
go back to reference Haidl P, Heindl S, Siemon K, Bernacka M, Cloes RM. Inhalation device requirements for patients’ inhalation maneuvers. Respir Med. 2016;118:65–75.CrossRef Haidl P, Heindl S, Siemon K, Bernacka M, Cloes RM. Inhalation device requirements for patients’ inhalation maneuvers. Respir Med. 2016;118:65–75.CrossRef
20.
go back to reference Gálffy G, Szilasi M, Tamási L. Effectiveness and patient satisfaction with budesonide/formoterol Easyhaler® among patients with asthma or COPD switching from previous treatment: a real-world study of patient-reported outcomes. Pulm Ther. 2019;5(2):165–77.CrossRef Gálffy G, Szilasi M, Tamási L. Effectiveness and patient satisfaction with budesonide/formoterol Easyhaler® among patients with asthma or COPD switching from previous treatment: a real-world study of patient-reported outcomes. Pulm Ther. 2019;5(2):165–77.CrossRef
21.
go back to reference Price D, Bosnic-Anticevich S, Briggs A, Chrystyn H, Rand C, Scheuch G, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir Med. 2013 Dec 20;107(1):37–46. Price D, Bosnic-Anticevich S, Briggs A, Chrystyn H, Rand C, Scheuch G, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir Med. 2013 Dec 20;107(1):37–46.
22.
go back to reference Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess. 2001;5(26). Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess. 2001;5(26).
23.
go back to reference O’Connor BJ. The ideal inhaler: design and characteristics to improve outcomes. Respir Med. 2004;98(Suppl A). O’Connor BJ. The ideal inhaler: design and characteristics to improve outcomes. Respir Med. 2004;98(Suppl A).
24.
go back to reference Lavorini F, Magnan A, Christophe Dubus J, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593–604.CrossRef Lavorini F, Magnan A, Christophe Dubus J, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593–604.CrossRef
25.
go back to reference Molimard M. How to achieve good compliance and adherence with inhalation therapy. Curr Med Res Opin. 2005;21(Suppl 4). Molimard M. How to achieve good compliance and adherence with inhalation therapy. Curr Med Res Opin. 2005;21(Suppl 4).
26.
go back to reference Thomas M, Williams AE. Are outcomes the same with all dry powder inhalers? Int J Clin Pract Suppl. 2005;59(149):33–5.CrossRef Thomas M, Williams AE. Are outcomes the same with all dry powder inhalers? Int J Clin Pract Suppl. 2005;59(149):33–5.CrossRef
27.
go back to reference Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9.CrossRef Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9.CrossRef
28.
go back to reference Sanchis J, Gich I, Pedersen S. Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394–406.CrossRef Sanchis J, Gich I, Pedersen S. Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394–406.CrossRef
29.
go back to reference Ocakli B, Ozmen I, Tunçay EA, Gungor S, Altinoz H, Adiguzel N, et al. A comparative analysis of errors in inhaler technique among COPD versus asthma patients. Int J Chron Obstruct Pulmon Dis. [Internet]. 2018;13:2941–7. Ocakli B, Ozmen I, Tunçay EA, Gungor S, Altinoz H, Adiguzel N, et al. A comparative analysis of errors in inhaler technique among COPD versus asthma patients. Int J Chron Obstruct Pulmon Dis. [Internet]. 2018;13:2941–7.
30.
go back to reference Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481–90.CrossRef Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481–90.CrossRef
31.
go back to reference Cerveri I, Locatelli F, Zoia M, Corsico A, Accordini S, de Marco R, et al. International variations in asthma treatment compliance: the results of the European Community Respiratory Health Survey (ECRHS). Eur Respir J. 1999;14:288–94.CrossRef Cerveri I, Locatelli F, Zoia M, Corsico A, Accordini S, de Marco R, et al. International variations in asthma treatment compliance: the results of the European Community Respiratory Health Survey (ECRHS). Eur Respir J. 1999;14:288–94.CrossRef
32.
go back to reference Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371–84.CrossRef Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371–84.CrossRef
33.
go back to reference George M. Adherence in asthma and copd: new strategies for an old problem. Respir Care. 2018;63(6):818–31.CrossRef George M. Adherence in asthma and copd: new strategies for an old problem. Respir Care. 2018;63(6):818–31.CrossRef
34.
go back to reference Aydemir Y. Assessment of the factors affecting the failure to use inhaler devices before and after training. Respir Med. 2015;109(4):451–8.CrossRef Aydemir Y. Assessment of the factors affecting the failure to use inhaler devices before and after training. Respir Med. 2015;109(4):451–8.CrossRef
35.
go back to reference Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018;9:353–67.CrossRef Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018;9:353–67.CrossRef
36.
go back to reference Deshpande P, Sudeepthi Bl, Rajan S, Abdul Nazir C. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011;2(4):137. Deshpande P, Sudeepthi Bl, Rajan S, Abdul Nazir C. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011;2(4):137.
37.
go back to reference Sandler N, Holländer J, Långström D, Santtila P, Saukkonen A, Torvinen S. Evaluation of inhaler handling-errors, inhaler perception and preference with Spiromax, Easyhaler and Turbuhaler devices among healthy Finnish volunteers: a single site, single visit crossover study (Finhaler). BMJ Open Respir Res. 2016;3(1). Sandler N, Holländer J, Långström D, Santtila P, Saukkonen A, Torvinen S. Evaluation of inhaler handling-errors, inhaler perception and preference with Spiromax, Easyhaler and Turbuhaler devices among healthy Finnish volunteers: a single site, single visit crossover study (Finhaler). BMJ Open Respir Res. 2016;3(1).
38.
go back to reference Rönmark P, Jagorstrand B, Safioti G, Menon S, Bjermer L. Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers. Eur Clin Respir J. [Internet]. 2018;5(1). Rönmark P, Jagorstrand B, Safioti G, Menon S, Bjermer L. Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers. Eur Clin Respir J. [Internet]. 2018;5(1).
39.
go back to reference Price DB, Thomas V, Richard Dekhuijzen PN, Bosnic-Anticevich S, Roche N, Lavorini F, et al. Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study. BMC Pulm Med. 2018;18(1):1–14.CrossRef Price DB, Thomas V, Richard Dekhuijzen PN, Bosnic-Anticevich S, Roche N, Lavorini F, et al. Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study. BMC Pulm Med. 2018;18(1):1–14.CrossRef
40.
go back to reference Virchow JC, Rodriguez-Roisin R, Papi A, Shah TP, Gopalan G. A randomized, double-blinded, double-dummy efficacy and safety study of budesonide–formoterol Spiromax® compared to budesonide–formoterol Turbuhaler® in adults and adolescents with persistent asthma. BMC Pulm Med. 2016;16(1). Virchow JC, Rodriguez-Roisin R, Papi A, Shah TP, Gopalan G. A randomized, double-blinded, double-dummy efficacy and safety study of budesonide–formoterol Spiromax® compared to budesonide–formoterol Turbuhaler® in adults and adolescents with persistent asthma. BMC Pulm Med. 2016;16(1).
41.
go back to reference Schreiber J, Sonnenburg T, Luecke E. Inhaler devices in asthma and COPD patients - a prospective cross-sectional study on inhaler preferences and error rates. BMC Pulm Med. 2020;20(1):1–12.CrossRefPubMedPubMedCentral Schreiber J, Sonnenburg T, Luecke E. Inhaler devices in asthma and COPD patients - a prospective cross-sectional study on inhaler preferences and error rates. BMC Pulm Med. 2020;20(1):1–12.CrossRefPubMedPubMedCentral
42.
go back to reference van der Palen J, Cerveri I, Roche N, Singh D, Plaza V, Gonzalez C, et al. DuoResp® Spiromax® adherence, satisfaction and ease of use: findings from a multi-country observational study in patients with asthma and COPD in Europe (SPRINT). J Asthma. 2020;57(10):1110–8. van der Palen J, Cerveri I, Roche N, Singh D, Plaza V, Gonzalez C, et al. DuoResp® Spiromax® adherence, satisfaction and ease of use: findings from a multi-country observational study in patients with asthma and COPD in Europe (SPRINT). J Asthma. 2020;57(10):1110–8.
43.
go back to reference Piedra Castro R, et al. Inhala ZS: Eficacia, control de la enfermedad y satisfacción con el dispositivo de inhalación en pacientes con asma. In: Semergen. 2019;45(Espec Congr 1):148. Piedra Castro R, et al. Inhala ZS: Eficacia, control de la enfermedad y satisfacción con el dispositivo de inhalación en pacientes con asma. In: Semergen. 2019;45(Espec Congr 1):148.
44.
go back to reference De Simón Gutiérrez R, et al. Inhala ZS: Eficacia, control de la enfermedad y satisfacción con el dispositivo de inhalación en pacientes con enfermedad pulmonar obstructiva. In: Semergen. 2019;5(Espec Congr 1):149. De Simón Gutiérrez R, et al. Inhala ZS: Eficacia, control de la enfermedad y satisfacción con el dispositivo de inhalación en pacientes con enfermedad pulmonar obstructiva. In: Semergen. 2019;5(Espec Congr 1):149.
45.
go back to reference Voorham J, Roche N, Benhaddi H, Van Der Tol M, Carter V, Van Boven JFM, et al. Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK. BMJ Open. 2018;8(10). Voorham J, Roche N, Benhaddi H, Van Der Tol M, Carter V, Van Boven JFM, et al. Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK. BMJ Open. 2018;8(10).
46.
go back to reference Voorham J, Roche N, Benhaddi H. Correction: Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK. BMJ Open. [Internet]. 2019;9(6):22051–3. Voorham J, Roche N, Benhaddi H. Correction: Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK. BMJ Open. [Internet]. 2019;9(6):22051–3.
47.
go back to reference Gillissen A, Gessner C, Hechenbichler K, Herth FJF, Juenemann R, Kanniess F, et al. Patient satisfaction and clinical outcomes with Budesonide plus formoterol spiromax for asthma and chronic obstructive pulmonary disease: a real-world, observational trial. Respiration. 2019;97(4):292–301.CrossRef Gillissen A, Gessner C, Hechenbichler K, Herth FJF, Juenemann R, Kanniess F, et al. Patient satisfaction and clinical outcomes with Budesonide plus formoterol spiromax for asthma and chronic obstructive pulmonary disease: a real-world, observational trial. Respiration. 2019;97(4):292–301.CrossRef
48.
go back to reference Roche N, Aguilaniu B, Paternotte S, Dallery N. Real-life association between inhaler technique, patient preference and asthma control in patients with uncontrolled asthma switched to budesonide/formoterol DuoResp® Spiromax® combination. J Asthma. 2021;0(0):1–10. Roche N, Aguilaniu B, Paternotte S, Dallery N. Real-life association between inhaler technique, patient preference and asthma control in patients with uncontrolled asthma switched to budesonide/formoterol DuoResp® Spiromax® combination. J Asthma. 2021;0(0):1–10.
Metadata
Title
Narrative Review of the Role of Patient-Reported Outcomes and Inhaler Handling Errors in the Control of Asthma and COPD
Authors
Raúl De Simón Gutiérrez
Raúl Piedra Castro
Publication date
10-09-2022
Publisher
Springer US
Published in
Current Allergy and Asthma Reports / Issue 11/2022
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-022-01041-2