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Ohbayashi H, Asano T, Kudo S, Ariga M. Comparison of User Satisfaction and Preference with Inhalant Devices Between a Pressurized Metered-Dose Inhaler and Ellipta in Stable Asthma Patients: A Randomized, Crossover Study. Pulm Ther 2021; 7:171-187. [PMID: 33651301 PMCID: PMC8137762 DOI: 10.1007/s41030-021-00149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Inhalation therapy involves two types of adherence: adherence to the drug and adherence to the procedures for the inhalation device. User satisfaction and preference are key factors for maintaining good adherence of both types, and they should be evaluated based on three conditions being well maintained: asthma control level (ACL), adherence, and adequate device operability during usage duration. We compared user satisfaction and preference between a pressurized metered-dose inhaler (pMDI) and a dry powder inhaler (Ellipta), while maintaining the three conditions during usage in stable asthma patients. Methods In this open-label, randomized, two-way crossover study, patients with stable asthma [Asthma Control Questionnaire (ACQ) scores < 0.75] were classified into a 20–64-year age group (G1) and a ≥ 65-year age group (G2) and randomly assigned to either a formoterol/fluticasone combination (FFC) as the pMDI group or a vilanterol/fluticasone combination (VFC) as the Ellipta group. Satisfaction and preference levels were evaluated at week 4. ACL was measured using the ACQ and Japan Asthma Control Survey questionnaires at weeks 0 and 4. Device operability and respiratory resistance were also examined. Results Forty-four patients (23 G1, age 45.8 ± 1.9 years; 21 G2, 74.1 ± 1.3 years) were enrolled and maintained good ACL during the study. Adherence to FFC pMDI and VFC Ellipta was > 97% in all groups. Device operability did not differ significantly between FFC pMDI and VFC Ellipta in the G1 (p = 0.189) or G2 (p = 0.506) group. Overall satisfaction was marginally higher with the FFC pMDI than with the VFC Ellipta in G2 (p = 0.012) but non-significantly different in G1 (p = 0.733). Factors affecting overall satisfaction in G2 were difference of inhalation device and body mass index. Respiratory resistance did not change significantly over the study in G2. Conclusion Based on maintaining good ACL, adherence, and device operability, FFC pMDI showed significantly higher satisfaction and preference levels than VFC Ellipta in elderly persons. Trial Registration Japan Registry of Clinical Trials identifier, jRCTs041180001 (registered 21 August 2018). Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00149-6.
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Affiliation(s)
- Hiroyuki Ohbayashi
- Department of Allergy and Respiratory Medicine, Tohno Chuo Clinic, Mizunami, Japan.
| | - Takamitsu Asano
- Department of Allergy and Respiratory Medicine, Tohno Chuo Clinic, Mizunami, Japan
| | - Sahori Kudo
- Department of Allergy and Respiratory Medicine, Tohno Chuo Clinic, Mizunami, Japan
| | - Mitsue Ariga
- Department of Allergy and Respiratory Medicine, Tohno Chuo Clinic, Mizunami, Japan
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Tang FSM, Rutting S, Farrow CE, Tonga KO, Watts J, Dame-Carrol JR, Bertolin A, King GG, Thamrin C, Chapman DG. Ventilation heterogeneity and oscillometry predict asthma control improvement following step-up inhaled therapy in uncontrolled asthma. Respirology 2020; 25:827-835. [PMID: 32026586 DOI: 10.1111/resp.13772] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/17/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Abnormal peripheral airway function is an important feature of asthma and relates to asthma symptoms and poor asthma control. We aimed to determine whether peripheral airway function, as measured by forced oscillatory impedance and multiple-breath nitrogen washout (MBNW), relates to symptom improvement in asthmatic participants with uncontrolled asthma, after stepping up to high-dose ICS/LABA treatment. METHODS A total of 19 subjects (14 females, mean age: 29.9 ± 13.6 years) with uncontrolled asthma, as defined by an ACQ5 > 1.5, taking 500 μg/day fluticasone equivalent or less, underwent spirometry, plethysmography, fractional exhaled FeNO, forced oscillatory resistance (Rrs5Hz ) and reactance (Xrs5Hz ), and indices of MBNW ventilation heterogeneity (lung clearance index (LCI), diffusion-convection-dependent (Sacin) and convection-dependent (Scond)). Measurements were made before and after 8 weeks of treatment with fluticasone/formoterol combination inhaler 250/10 μg, 2 puffs twice daily. RESULTS Treatment improved ACQ5 (P = 0.0002), FEV1 (P = 0.02), FVC (P = 0.04), FeNO (P = 0.0008), Xrs5Hz (P = 0.01), LCI (P = 0.0002), Sacin (P = 0.006) and Scond (P = 0.01). At baseline, ACQ5 correlated with Xrs5Hz (rs = 0.52, P = 0.03) and Rrs5Hz (rs = 0.55, P = 0.02). The improvement in ACQ5 was predicted by more abnormal baseline LCI (P = 0.03), Scond (P = 0.02) and Rrs5Hz (P = 0.006). Baseline Scond was the best predictor of a clinically meaningful improvement in asthma control (ΔACQ > 0.5, ROC-AUC = 0.91, P = 0.007). CONCLUSION Step-up to high-dose combination treatment in uncontrolled asthma is associated with improved peripheral airway function as measured by Xrs5Hz and MBNW. Baseline MBNW and FOT parameters correlated with the improvement in symptoms and may predict a positive response to up-titration in uncontrolled asthmatic patients.
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Affiliation(s)
- Francesca S M Tang
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Sandra Rutting
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia
| | - Catherine E Farrow
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Katrina O Tonga
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Department of Thoracic and Transplant Medicine, St Vincent's Hospital, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Joanna Watts
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Jessica R Dame-Carrol
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Amy Bertolin
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G King
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Excellence in Severe Asthma, Newcastle, NSW, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - David G Chapman
- Airway Physiology and Imaging Group, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
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Usmani O, Roche N, Marshall J, Danagher H, Price D. An innovative corticosteroid/long-acting β 2-agonist breath-triggered inhaler: facilitating lung delivery of fluticasone propionate/formoterol fumarate for the treatment of asthma. Expert Opin Drug Deliv 2019; 16:1367-1380. [PMID: 31752560 DOI: 10.1080/17425247.2019.1689957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Incorrect inhaler technique is one reason why the efficacies of inhaled asthma treatments in clinical trials and effectiveness in the real world differ. Inhaler technique is critical for drug delivery to the lungs; incorrect technique negatively impacts asthma control and long-term outcomes. Breath-triggered inhalers (BTIs) can simplify drug administration and are suitable for most patients, including those with reduced inspiratory flow. Until recently, no inhaled corticosteroid/long-acting β2-agonist combination BTI was available in Europe. The flutiform® (fluticasone propionate/formoterol fumarate [FP/FORM]) k-haler® is the first combination BTI now approved in Europe for asthma maintenance treatment.Areas covered: We review studies examining the challenges posed to patients by different inhaler types and explore evidence demonstrating the clinical efficacy of FP/FORM administered via a pressurized metered-dose inhaler. We also review the pharmacokinetic/pharmacodynamic studies supporting FP/FORM k-haler use, and consider data showing high lung deposition with the device. Finally, we review patient experiences using the BTI, device characteristics, and health economic aspects.Expert opinion: Despite the availability of therapies, asthma control levels remain low, and there is a clear need for easy-to-use inhalers. Research to increase our understanding of critical errors with each inhaler and how to overcome them is important for improving care.Abbreviations: AUCt: area under the plasma concentration-time curve from the time of dosing to the last measurable concentration; BDP: beclometasone dipropionate; BTI: breath-triggered inhaler; BUD: budesonide; CI: confidence interval; Cmax: maximum observed plasma concentration; DPI: dry powder inhaler; FDC: fixed-dose combination; FEV1: forced expiratory volume in 1 s; FORM: formoterol fumarate; FP: fluticasone propionate; HCP: health-care professional; ICS: inhaled corticosteroid; LABA: long-acting β2-agonist; OR: odds ratio; PIL: patient information leaflet; pMDI: pressurized metered-dose inhaler; SAL: salmeterol xinafoate.
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Affiliation(s)
- Omar Usmani
- National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, UK
| | - Nicolas Roche
- Cochin Hospital (APHP), University Paris Descartes, Paris, France
| | | | - Helen Danagher
- Mundipharma International Technical Operations, Cambridge, UK
| | - David Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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