scholarly journals A Bayesian Framework to Assess the Usability of Dry Powder Inhalers in a Cohort of Asthma Adolescents in Italy

Children ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 28
Author(s):  
Roberto Walter Dal Negro ◽  
Massimiliano Povero
Keyword(s):  
Short Form ◽  
Indirect Comparison ◽  
Real Life ◽  
Pairwise Comparisons ◽  
Dry Powder Inhalers ◽  
Current Clinical Practice ◽  
Dry Powder ◽  
Asthma Patients ◽  
Time Required ◽  
Short Time

The useability of DPIs (dry powder inhalers) depends on several factors that are influenced by the patients’ subjectivity and objectivity. The short-form global usability score (S-GUS), a specific tool for the quick ranking and comparison in real life of an inhaler’s usability, was used to investigate six of the most prescribed DPIs (Breezhaler, Diskus, Ellipta, Nexthaler, Spiromax, and Turbohaler) in consecutive asthma patients aged <18 years. A Bayesian indirect comparison (IC) was carried out to merge all pairwise comparisons between the six DPIs. Thirty-three subjects participated: eighteen tested Breezhaler, Spiromax, Nexthaler, and Ellipta simultaneously, while fifteen tested Breezhaler, Spiromax, Diskus, and Turbohaler. The estimates of the S-GUS, by the IC model, allowed us to rank the DPIs by their degree of usability: Ellipta, Diskus, and Spiromax were classified as “good to pretty good” (S-GUS > 15), while Spiromax, Turbohaler, and Breezhaler were classified as “insufficient” (S-GUS < 15). The multidomain assessment is recommended in asthma adolescents in order to approximate the effective usability of different DPIs as best as possible. The S-GUS proves particularly suitable in current clinical practice because of the short time required for its use in adolescents.

scholarly journals Patients' usability of seven most used dry-powder inhalers in COPD

2019 ◽  
Vol 14 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Paola Turco ◽  
Massimiliano Povero
Keyword(s):  
Indirect Comparison ◽  
Real Life ◽  
Small Sample ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Inhalation Devices ◽  
Therapeutic Outcomes ◽  
Copd Patients ◽  
Specialist Centre ◽  
Ranking Order

Introduction: Inhalation devices affect both the effectiveness and the therapeutic outcomes in persistent airway obstruction, and the effects are largely independent of the drug(s) assumed. Usability is a complex and comprehensive indicator of inhalation devices’ performance. The Global Usability Score (GUS) Questionnaire is an investigational tool designed to assess objectively the patients’-related and unrelated domains of devices’ usability. Methods: The GUS questionnaire was administered to all consecutive COPD patients referring for three months to the Lung Unit of CEMS Specialist Centre (Verona, Italy). The usability of seven Dry Powder Inhalers (DPIs) indicated as appropriate in COPD was tested and compared: Breezhaler, Diskus, Ellipta, Genuair, Nexthaler, Spiromax, and Turbohaler. Patients were divided in two groups, checked separately, according to their DPIs previous experience. A Bayesian Indirect Comparison (IC) model was built to assess “global usability” ranking. Results: A total of 103 patients were investigated: 74 patients already instructed in DPI use and 29 naive to DPIs. IC analysis proved Ellipta as the device characterized by the highest usability, while Breezhaler the device with the lowest usability in both groups of COPD patients (both with probability > 90%). Moreover, Turbohaler ranked second according to the Bayesian pooling, followed by Diskus, Spiromax, Nexthaler, and Genuair in patients already instructed in DPI use, while the ranking order was not as much well defined in naïve patients, likely due to their too small sample. Conclusions: Usability is a multifaceted indicator that contributes to assess the factual DPIs’ convenience in real life. DPIs are characterized by different levels of real-life usability, which can be checked, compared and ranked by means of the GUS score.

scholarly journals The Global Usability Score Short-Form for the simplified assessment of dry powder inhalers (DPIs) usability

2020 ◽  
Vol 15 ◽  
Author(s):  
Massimiliano Povero ◽  
Paola Turco ◽  
Luca Bonadiman ◽  
Roberto W. Dal Negro
Keyword(s):  
Clinical Practice ◽  
Short Form ◽  
Objective Assessment ◽  
Indirect Comparison ◽  
Real Life ◽  
Dry Powder Inhaler ◽  
High Specificity ◽  
Lasso Regression ◽  
Dry Powder ◽  
Specificity And Sensitivity

Background: The choice of the Dry Powder Inhaler (DPI) to prescribe is a critical issue. The estimation of DPIs usability depends on the objective assessment of several indices related to both subjective and objective determinants. The Global Usability Score (GUS) Questionnaire is a comprehensive tool usable for checking, comparing, and ranking inhalers’ usability objectively in real life, but it takes some time to fill.Aim: The aim of this study was to favour the quicker check of DPIs usability in clinical practice by means of a simplified short-form GUS (S-GUS) Questionnaire, while maintaining the high specificity and sensitivity of the original, extended version of the Questionnaire (O-GUS questionnaire).Methods: The usability of the six most prescribed DPIs was assessed in 222 patients with persistent airway obstruction and needing long-term inhalation treatments. LASSO regression and multicollinearity test were used to select the subset of questions of the O-GUS questionnaire, with the highest information power. Each item was then scored using the corresponding coefficient in the linear regression (normalized at 50 as the O-GUS score). Agreement between the original and the short-form questionnaire was evaluated using the Cohen’s kappa statistic (κ). The overall S-GUS values obtained for each DPI were then compared to those from the O-GUS, in the same patients, using a Bayesian indirect comparison (IC) model.Results: After the statistical selection of the items mostly contributing to the overall score, the novel S-GUS questionnaire consists of twelve items only. Nine items are related to patients’ opinion before DPIs handling, and three to the nurse’s assessment after DPIs practicality. O-GUS and S-GUS score were strongly correlated (R2=0.9843, p<0.0001) and the usability score calculated for each DPI by means of the O- and of S- GUS overlapped almost completely (κ=84.5%, 95% CI 81.3% to 89.2%). Furthermore, S-GUS was much faster to complete than O-GUS (mean time 6.1 vs 23.4 minutes, p<0.001). Estimates of S-GUS, obtained from the IC model, allowed to propose a simple classification of usability: “good” by GUS values >25; “pretty good” by values ≤25≥15, and “insufficient” by values <15.Conclusions: The S-GUS proves as much specific and suitable as the extended O-GUS questionnaire in measuring DPIs usability, while maintaining the same high sensitivity. As the time required for its use is quite shorter, S-GUS is also particularly suitable and helpful in current clinical practice.

scholarly journals Preference for Easyhaler® Over Previous Dry Powder Inhalers in Asthma Patients: Results of the DPI PREFER Observational Study

2021 ◽  
Vol Volume 15 ◽  
pp. 349-358
Author(s):  
Francisco Javier Alvarez-Gutiérrez ◽  
Ana Gómez-Bastero Fernández ◽  
Juan Francisco Medina Gallardo ◽  
Carlos Campo Sien ◽  
Paula Rytilä ◽  
...  
Keyword(s):  
Observational Study ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Asthma Patients

scholarly journals Correction to: Patients’ usability of seven most used dry-powder inhalers in COPD

2019 ◽  
Vol 14 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Paola Turco ◽  
Massimiliano Povero
Keyword(s):  
Real Life ◽  
Original Research ◽  
Dry Powder Inhalers ◽  
Original Research Article ◽  
Dry Powder ◽  
Intrinsic Resistance ◽  
Research Article ◽  
Copd Patients ◽  
Basic Characteristics

Correction to: Multidiscip RespirMed (2019) 14:30 https://doi.org/10.1186/s40248-019-0192-5After publication of the Original research article [1] it was brought to our attention that the sentence at the bottom of the section entitled Discussion (pag 6 of 9, just below Fig. 4) must be corrected as follows: “In real life, DPIs are highly prescribed in Italian COPD patients being their prescription usually independent of their known basic characteristics and technical differences, such as the different number of main actions required for their actuation (7 for Breezhaler, 4 for Turbohaler, and 3 for the remaining devices),” and their intrinsic resistance, ranging from 0.017 kPa0.5 L/min to 0.039 kPa0 .5 L/min [28, 29].

An Optical Method for the Study of Aerosol Generation in Dry Powder Inhalers

Volume 3 ◽  
2004 ◽  
Author(s):  
Henk K. Versteeg ◽  
Ricky D. Wildman
Keyword(s):  
High Speed ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Development Activity ◽  
Aerosol Generation ◽  
Video Recordings ◽  
Air Jet ◽  
Challenging Environment ◽  
Processing Techniques ◽  
Short Time

Dry powder inhalers (DPIs) are portable, breath-actuated devices used for respiratory drug delivery. They have been the subject of intense research and development activity over the last 15 years, however, no systematic study of the effects of geometry on aerosol generation in DPIs has been reported in the literature. In particular, the first stage process — powder fluidisation — has hardly been studied in the context of DPI applications. The short time scales and the complexities of the air/powder interactions during the conversion of a powder bed into an aerosol present a challenging environment for experimental study. This paper reports an optical technique for the study of powder fluidisation inside a simplified, optically transparent DPI metering chamber geometry. We describe a system based on digital image analysis of high-speed video recordings of the transient powder-airflow interactions. Using diffuse backlighting we have generated black-on-white images of the interaction of frictional, cohesionless particles with an air jet flow. Image-processing techniques were subsequently applied to determine several aspects of the time-dependent properties that describe the development of the bed during the aeration of the powder. The paper concludes by pointing out how the proposed method could be used to improve understanding of the limitations associated with current DPI metering chamber configurations and help forward design of improved DPIs.

scholarly journals Real‐life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred‐dose inhalers in patients with asthma treated with ICS/LABA

Respirology ◽  
2019 ◽  
Vol 24 (10) ◽  
pp. 972-979 ◽  
Author(s):  
Hae‐Sim Park ◽  
Dukyong Yoon ◽  
Hyun Young Lee ◽  
Ga‐Young Ban ◽  
Simon Wan Yau Ming ◽  
...  
Keyword(s):  
Real Life ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Life Effectiveness ◽  
Inhaler Device
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