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Satisfaction, preference and error occurrence of three dry powder inhalers as assessed by a cohort naïve to inhaler operation

Authors Man KN, Tian Z, Lam DCL, Wan JMF, Tan-Un KC

Received 21 September 2017

Accepted for publication 5 January 2018

Published 15 June 2018 Volume 2018:13 Pages 1949—1963

DOI https://doi.org/10.2147/COPD.S152285

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 4

Editor who approved publication: Professor Chunxue Bai


Kwun Nok Mimi Man,1,* Zhipeng Tian,1,* David Chi-Leung Lam,2 Jennifer Man Fan Wan,3 Kian Cheng Tan-Un1

1University of Hong Kong, School of Professional and Continuing Education, Hong Kong SAR, China; 2University of Hong Kong, Department of Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong SAR, China; 3University of Hong Kong, School of Biological Sciences, Hong Kong SAR, China

*These authors contributed equally to this work


Background: Inhaled medication is central to the treatment of COPD. Various types of inhaler devices, which directly deliver medication to the lung, have been developed. However, patients often exhibit incorrect techniques of inhaler usage. Effectiveness of therapy may be affected by the ease of device usage, size, convenience of use, durability, clarity of instructions and device preferences of patients. This study compares the satisfaction and preference, as well as error occurrence, with the use of Genuair®, Ellipta™ and Breezhaler™ by healthy subjects in Hong Kong.
Subjects and methods: One hundred and thirty healthy Hong Kong Chinese subjects aged ≥40 years without a previous diagnosis of COPD and asthma and with no experience of using dry powder inhalers (DPIs) were recruited. Subjects learned to use the three DPIs by initially reading the instructions and then observing a demonstration with verbal explanation. The number of errors committed was evaluated. Subjects also completed a questionnaire to indicate their satisfaction and preference.
Results: The satisfaction score of comfort for Breezhaler was significantly higher than that for Ellipta (p≤0.05), while the satisfaction score on confidence to have inhaled the entire dose was highest for Genuair compared with Ellipta (p≤0.0001) or Breezhaler (p≤0.05). The overall satisfaction score was significantly higher for Genuair than Ellipta (p≤0.05) or Breezhaler (p≤0.01). After reading the instructions, the highest number of subjects committing one or more critical errors was with Breezhaler (97) followed by Genuair (70) and then Ellipta (33). Demonstration reduced the number of critical errors made by subjects for each DPI to one third or lower.
Conclusion: Breezhaler seemed to be more comfortable and easy to carry, but users made less critical errors when using Ellipta after reading the instructions only. Genuair provided the clearest indication of correct dose preparation and inhalation.

Keywords: chronic obstructive pulmonary disease, inhalation device, Genuair®, Ellipta™, Breezhaler™

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