Background: Inhalation therapy is the backbone of asthma and COPD control. However, inhaler adherence and
device mishandling continue to be a problem in real life. Some studies have shown that using a patient-preferred
inhaler may reduce device handling errors and improve adherence to prescribed chronic inhaler drug therapy. The
aim of this study was to compare the preferences for commonly used inhaler devices in Germany in patients with
chronic obstructive respiratory disease. We also pursued the question which properties of an inhaler device are
particularly important to the user and what effects age, gender and type of disease (asthma or COPD) may have on
device preference and handling errors.
Methods: Prospective, open-label cross-sectional study in which 105 patients with asthma (58%) or COPD (42%)
participated. Validated checklists were used to objectively assess inhaler technique and errors with 10 different
placebo devices. For each device, patients were asked to test the handling, to assess the device properties and to
name the device that they would most or least prefer.
Results: Across the 10 placebo inhaler devices tested, patients needed an average of 1.22 attempts to error-free
use. The device with the lowest mean number of attempts was the Turbohaler® (1.02), followed by the Nexthaler®
(1.04), the Diskus® (1.07) and the Spiromax® (1.10). Patients over 60 years vs. younger age (p = 0.002) and COPD vs.
asthma patients (p = 0.016) required more attempts to ensure correct use. 41% of the study participants chose one
of the devices they already used as the most preferred inhaler. Overall, 20% opted for the Spiromax®, 15% for the
Nexthaler® and 14% for the Turbohaler® or a pMDI. The least preferred device was the Elpenhaler® (0%). From a
selection of 7 predefined inhaler attributes, patients stated easy handling as the most important for them. This was
followed by short inhalation time and low inhalation resistance.
Conclusions: Patient preference may vary between inhaler devices. The lowest number of attempts to error-free
use was reported for the Turbohaler® and the Nexthaler®. The Spiromax® and the Nexthaler® achieved the best
overall ratings and were the devices most preferred by patients.DFG-Publikationsfonds 202
