AB036. Real-life experience of COPD patients on ease and accuracy of inhaler use: the REAL survey

Background: Many patients with chronic obstructive pulmonary disease (COPD) achieve incomplete benefit from their treatment, due to reasons including inadequate device training or incorrect inhaler technique. Dosing frequency has also been shown to impact COPD treatment compliance with inhaler overuse and underuse being the most common form of noncompliance. Between 28–68% of patients do not use their inhalers correctly, and 39–67% of health care professionals (HCPs) do not effectively train patients to correctly use their inhalers. This makes patients prone to committing inhaler use errors and may negatively impact treatment compliance. We conducted a computer-assisted telephonic survey in patients with COPD to evaluate patient-reported insights on real life aspects of inhaler use, training and check for correct use by HCP, device attributes and patient-reported compliance of inhaler or medication use.

Methods: Patients from 9 countries, diagnosed with mild to very severe COPD and using maintenance inhaled treatment (via Breezhaler^®, Ellipta^®, Genuair^®, Respimat^®) were included in this survey. Patient-reported data on correct inhaler use (training and check), inhalation pattern, and device attributes (ease of use and confidence of inhaling full dose), compliance and potential underuse or overuse was collected. Chi-square test was performed for testing significance and z-test was used for comparisons of proportions (significance level: alpha<0.05).

Results: A total of 764 patients (Breezhaler^® =186; Ellipta^® =191; Genuair^® = 194; Respimat^® =201) with mild to very severe COPD with a mean (±SD) age 56±9.8 years, completed the survey. Approximately, 30% of all patients reported not receiving any inhaler use training. Of the 70%, who received training on inhaler use, 83% felt that the demonstration of inhaler use was very helpful, followed by videos (58%), instructions for use (51%) and leaflets (34%), irrespective of the device used. About 29% of all patients reported never being checked for correct inhaler technique. Most patients (76–93%) were confident or very confident of having taken the full dose. Of the patients who did not feel confident having taken the full dose, approximately 4–33% patients reported having inhaled another dose at the same time. Most patients (91–97%) were taking the correct dose (1 puff per dose, once daily), except for Respimat^® where only 50% of them were taking the correct dose (i.e., 2 puffs per dose per day).

Conclusions: Insights collected from this patient-reported survey shows low incidence of training or monitoring (by HCPs) for correct inhaler use. Devices that provide low confidence of having inhaled the full dose may result in under-use or over use of medication, which may also impact efficacy and/or safety outcomes in patients. The results also highlight the need for enhancing the HCP-patient interaction through effective training programs. Considering that patients with COPD self-administer their medication, these insights should be considered for successful management of COPD.

Keywords: Chronic obstructive pulmonary disease (COPD); inhaler; health care professionals (HCPs)