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 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].

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 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 Carbon footprint impact of the choice of inhalers for asthma and COPD

Thorax ◽  
2019 ◽  
Vol 75 (1) ◽  
pp. 82-84 ◽  
Author(s):  
Christer Janson ◽  
Richard Henderson ◽  
Magnus Löfdahl ◽  
Martin Hedberg ◽  
Raj Sharma ◽  
...  
Keyword(s):  
Greenhouse Gases ◽  
Carbon Footprint ◽  
Dry Powder Inhalers ◽  
Metered Dose Inhalers ◽  
Dry Powder ◽  
Inhalation Devices ◽  
Metered Dose ◽  
Annual Carbon ◽  
Annual Reduction ◽  
Lower Carbon

In the 1990s, metered dose inhalers (MDIs) containing chlorofluorocarbons were replaced with dry-powder inhalers (DPIs) and MDIs containing hydrofluorocarbons (HFCs). While HFCs are not ozone depleting, they are potent greenhouse gases. Annual carbon footprint (CO2e), per patient were 17 kg for Relvar-Ellipta/Ventolin-Accuhaler; and 439 kg for Seretide-Evohaler/Ventolin-Evohaler. In 2017, 70% of all inhalers sold in England were MDI, versus 13% in Sweden. Applying the Swedish DPI and MDI distribution to England would result in an annual reduction of 550 kt CO2e. The lower carbon footprint of DPIs should be considered alongside other factors when choosing inhalation devices.

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

scholarly journals In Vitro, Pharmacokinetic, Pharmacodynamic, and Safety Comparisons of Single and Combined Administration of Tiotropium and Salmeterol in COPD Patients Using Different Dry Powder Inhalers

2015 ◽  
Vol 17 (4) ◽  
pp. 871-880 ◽  
Author(s):  
Stephen T. Horhota ◽  
Jan A. van Noord ◽  
Cynthia B. Verkleij ◽  
Loek J. Bour ◽  
Ashish Sharma ◽  
...  
Keyword(s):  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Copd Patients ◽  
Combined Administration

scholarly journals Dry-powder inhalers in patients with persistent airflow limitation: usability and preference

2016 ◽  
Vol 11 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Massimiliano Povero
Keyword(s):  
Point Of View ◽  
Wilcoxon Test ◽  
Airflow Limitation ◽  
Inhalation Therapy ◽  
General Point ◽  
Chronic Obstructive ◽  
Dry Powder Inhalers ◽  
Dry Powder ◽  
Obstructive Pulmonary Disease ◽  
Therapeutic Outcomes

Background: Inhalation devices represent per sé critical factors because they can affect the therapeutic outcomes independently of the drug used. The role of patients’ usability and preference (PUP) for Dry Powder Inhalers (DPIs) is high indeed because they can influence the extent of the adherence to treatment and the therapeutic outcomes. Aim of the study was to assess and compare the PUP of three different DPIs in out-patients with persistent airflow limitation due to asthma or COPD. Methods: The PUP of three different DPIs (Breezhaler; Genuair; Handihaler) were investigated by means of the Handling Questionnaire in out-patients with persistent airflow limitation needing an inhalation therapy. Patients had to report their preference before and after the nurse’s instruction on the handling of each device. The nurse had also to note the critical steps during the patient’s procedure for actuation; to count the number of attempts needed for actuating the device properly, and to measure the time (in sec.) required for these procedures. Data were collected up to three attempts per device. Statistics: Welch test was used for normal distributed variables, while the Wilcoxon test for not normal distributed variables. The χ2 test and the ANOVA test were also used. Univariate and multivariate regressions were also performed in order to investigate the effect of patients’ characteristics and of technical differences of each device on their proper use. Results: Three hundred thirty-three consecutive out-patients (age range 55–58 years, and well matched for gender), with persistent airway limitation of different severity were investigated, suffering from bronchial asthma (n = 175) or from chronic obstructive pulmonary disease (COPD) (n = 158). In particular, 127 patients (38 %) tested the three DPIs, while 110 (33 %) tested Breezhaler and Genuair, and 96 (29 %) Breezhaler and Handihaler. More than 50 % of patients who tested all devices preferred the Genuair and perceived this device as the easiest to use. The nurse’s judgement confirmed their opinion. When compared to the other two DPIs, Genuair proved the least problematic either according to the patients’ judgement and to the nurse’s opinion. Mean number of attempts aimed to achieving the first proper actuation was lower with Genuair than with Breezhaler and Handihaler (1.5 vs 2.5–2.6, p < 0.0001). Finally, Genuair also proved the easiest to use and the least problematic according to the nurse judgement (0.0001), the most easily learned (0.0001), and that one with a successful rate of more than 56 % at the first attempt. Breezhaler and Handihaler needed an average of about one additional attempt to be used properly (p < 0.0001), and their usability proved significantly more difficult (OR of successful rate between 0.15 and 0.17, p < 0.001). In general, older patients needed more attempts to perform their first proper inhalation; their successful rate was lower, and they needed more time to learn how to use devices properly: with Genuair these differences were minimized. Conclusions: The possibility of grading objectively the performance of different DPIs in terms of their usability and therapeutic convenience in daily life represents a crucial operational opportunity to pursue. To note that a substantial discrepancy exists between the patients’ belief “at glance” and the patients’ effective usability with can be registered with some devices. From a general point of view, devices requiring less manual actions for their actuation confirmed their better usability and proper handling after less attempts. In particular, Genuair came out as the most preferred DPI also when several different aspects of preference and usability are assessed objectively and compared.

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