Dal Negro Roberto W, Povero Massimiliano
National Centre for Respiratory Phamacoeconomics & Pharmacoepidemiology, CESFAR, Verona, Italy.
AdRes Health Economics and Outcome Recourses, Torino, Italy.
Multidiscip Respir Med. 2016 Feb 10;11:7. doi: 10.1186/s40248-016-0044-5. eCollection 2015.
BACKGROUND: The patients' criteria of preference for inhalation devices can affect the extent of their adherence to treatment and outcomes. Aim of this study was to assess and compare the patients' preference and acceptability (PPA) for Breezhaler and Genuair (both Dry Powder Inhalers), and for Respimat (a Soft Mist Inhaler) in asthma and COPD out-patients by means of the Handling Questionnaire. METHODS: The Handling Questionnaire is a validated instrument which allows the investigation of different domains of PPA; it also takes into account the patients' age and gender, together with their previous experience with the inhalation devices and their previous education approach to them. Differences in terms of preference, acceptance and usability were assessed by linear and logistic regressions in order to evaluate factors influencing the proper actuation. RESULTS AND DISCUSSION: Data from 333 patients were collected: Genuair and Respimat were the most liked and perceived as the easiest to use at glance by patients, but also as the least problematic according to the patients' and nurse's judgments. Mean number of attempts for achieving the first effective actuation was the highest with Breezhaler (2.6 vs 1.6; p <0.0001). Linear regressions showed that longer the explanation, higher was the number of attempts to the first proper actuation (0.58 additional attempts every 10 s increase in the first explanation, p <0.0001). Devices requiring less manoeuvres for the actuation were used properly after less attempts (0.38 increase in the number of attempts every additional manoeuvres, p <0.0001). Respimat proved to be the most indicated in COPD patients since it was the most liked and its successful rate at first attempt was the highest. Logistic regressions confirmed these data. Previous experience with DPIs and/or MDIs did not affect the patient preference and acceptability, independently whether suffering from asthma or COPD. CONCLUSIONS: Substantial differences are existing in patient's preference and acceptability for inhalation devices, mainly related to the handling and the understanding of the different devices.
背景：患者对吸入装置的偏好标准会影响其治疗依从性和治疗效果。本研究的目的是通过操作问卷评估并比较哮喘和慢性阻塞性肺疾病（COPD）门诊患者对都保（Breezhaler）和易纳器（Genuair，均为干粉吸入器）以及思力华能倍乐（Respimat，软雾吸入器）的偏好和可接受性（PPA）。 方法：操作问卷是一种经过验证的工具，可用于调查PPA的不同方面；它还考虑了患者的年龄和性别，以及他们以前使用吸入装置的经验和以前对这些装置的教育方式。通过线性回归和逻辑回归评估偏好、接受度和易用性方面的差异，以评估影响正确操作的因素。 结果与讨论：收集了333例患者的数据：易纳器和思力华能倍乐最受患者喜爱，患者一眼就能看出它们最易于使用，而且根据患者和护士的判断，它们也是问题最少的。都保首次实现有效操作的平均尝试次数最高（2.6次对1.6次；p<0.0001）。线性回归显示，解释时间越长，首次正确操作的尝试次数越高（第一次解释每增加10秒，额外增加0.58次尝试，p<0.0001）。操作所需动作较少的装置在较少尝试后就能正确使用（每增加一个动作，尝试次数增加0.38次，p<0.0001）。思力华能倍乐在COPD患者中被证明是最适用的，因为它最受喜爱且首次尝试成功率最高。逻辑回归证实了这些数据。以前使用干粉吸入器（DPI）和/或定量吸入器（MDI）的经验并不影响患者的偏好和可接受性，无论患者患有哮喘还是COPD。 结论：患者对吸入装置的偏好和可接受性存在显著差异，主要与不同装置的操作和理解有关。
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