Elsevier

Respiratory Medicine

Volume 97, Issue 10, October 2003, Pages 1126-1133
Respiratory Medicine

Assessment of patient performance of the HandiHaler® compared with the metered dose inhaler four weeks after instruction

https://doi.org/10.1016/S0954-6111(03)00162-8Get rights and content
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Abstract

The HandiHaler® is a novel breath-actuated dry powder system designed for the delivery of tiotropium 18 μg daily in the treatment of COPD. We compared patient ability to use the HandiHaler® or metered dose inhaler (MDI) device correctly 4 weeks after receiving brief instructions and device demonstration. A single-blind study was conducted in COPD patients in two centers in Denmark. All patients (n=151) received one placebo capsule via the HandiHaler® daily and ipratropium (20 μg) two actuations via the MDI q.i.d. Mean FEV1 for all patients was 1.25+0.54 (46% predicted). Twelve instructions establishing proper device use were evaluated for the MDI and Handihaler. Error scores were analyzed by number of patients with less, equal or more errors when using HandiHaler® compared to MDI in the total efficacy population (n=139) and according to those who had not previously used an MDI for at least 12 months (MDI beginners) (n=74) and those who had used an MDI (MDI experienced) (n=65). Four weeks after device instruction, a higher proportion of patients in the total population (P<0.01) had fewer errors with the HandiHaler® (35.3%) compared to the MDI (15.1%). The number of errors was equal in 50% of patients. Similar findings were observed in the subgroup of patients who were MDI beginners (42% vs. 11%, P<0.01) with non-significant trends in favor of the HandiHaler® in those patients who were MDI experienced (29.7% vs. 18.9%, P=0.096). Similar results in favor of HandiHaler® were noted across different age and sex strata. The proportion of patients correctly using the device on the first of three attempts was 59.7% and 54.7% for the HandiHaler® and MDI, respectively (P=0.399). In summary, use of the HandiHaler® can be easily taught with fewer errors compared to the MDI. Furthermore, patient performance using the HandiHaler® was superior to that with an MDI despite prior MDI experience and more frequent usage.

Keywords

Device
Bronchodilator
Chronic obstructive pulmonary disease
Performance
Tiotropium
Inhaler technique

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