Price David, Keininger Dorothy L, Viswanad Boomi, Gasser Matthias, Walda Susann, Gutzwiller Florian S
Division of Applied Health Sciences, Academic Primary Care, University of Aberdeen, Aberdeen, UK.
Observational and Pragmatic Research Institute, Singapore.
Int J Chron Obstruct Pulmon Dis. 2018 Feb 26;13:695-702. doi: 10.2147/COPD.S149404. eCollection 2018.
Nonadherence to medication and incorrect use of inhalers represent significant barriers to optimal disease management of patients with chronic obstructive pulmonary disease (COPD). Thus, health care professionals (HCPs) play a critical role in educating their patients on appropriate inhaler use and in ensuring medication adherence. However, many patients do not receive appropriate inhaler training or have not had their inhaler technique checked.
The Real-life Experience and Accuracy of inhaLer use (REAL) survey was a computer-assisted, telephonic survey consisting of 23 questions gathering real-world information on correct inhaler use, inhalation technique, device attributes, adherence, dosing accuracy, training, correct device use, ease of use, and factors that influence patient adherence in commercially available inhalers delivering COPD maintenance therapy. All results are based on patient-reported data.
The survey was conducted between January 4, 2016 and February 2, 2016. A total of 764 patients using various inhalers (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. Patient self-reported adherence was significantly lower in younger patients compared to older patients (=0.020). Eighty-three percent of patients indicated that a demonstration (in-person) was "very helpful" versus 58% for video. Patient preferences for training methods were as follows: demonstration of inhaler use (83%), video (58%), instructions for use (51%), and leaflet (34%). Twenty-nine percent of patients had not been checked to see if they were using their device correctly by a HCP within the last two years. Patients who were checked were significantly more adherent than unchecked patients (=0.020). The majority of the patients using Breezhaler reported either being very confident or confident of having taken a full dose, which was higher than those using Genuair, Ellipta (α=0.05), and Respimat (α=0.05). Treatment adherence in the last 30 days was highest with Breezhaler followed by Respimat, Ellipta, and Genuair.
The REAL survey identified attributes that influenced patient adherence and optimal inhaler use. Predictive attributes that influence patient adherence which HCPs should be aware of include age and disease severity. Modifiable attributes which the HCP can influence include correct inhaler use training, choice of training methods, checking patient inhaler technique at subsequent visits, and device selection. Inhalers are integral in the effective management of patients with COPD; it is therefore important that patients use the inhaler correctly and have full confidence in the dosage.
不坚持用药以及吸入器使用不当是慢性阻塞性肺疾病（COPD）患者实现最佳疾病管理的重大障碍。因此，医疗保健专业人员（HCPs）在教育患者正确使用吸入器以及确保药物依从性方面发挥着关键作用。然而，许多患者没有接受适当的吸入器培训，或者其吸入器使用技术未得到检查。
吸入器使用的实际经验与准确性（REAL）调查是一项计算机辅助电话调查，由23个问题组成，收集关于正确吸入器使用、吸入技术、装置属性、依从性、剂量准确性、培训、正确装置使用、易用性以及影响使用COPD维持治疗商用吸入器的患者依从性的因素等真实世界信息。所有结果均基于患者报告的数据。
该调查于2016年1月4日至2016年2月2日进行。共有764名使用各种吸入器（Breezhaler = 186；Ellipta = 191；Genuair = 194；Respimat = 201）的轻至重度COPD患者完成了调查，平均年龄±标准差为56±9.8岁。与老年患者相比，年轻患者自我报告的依从性显著更低（P = 0.020）。83%的患者表示亲自示范“非常有帮助”，而视频示范的这一比例为58%。患者对培训方法的偏好如下：吸入器使用示范（83%）、视频（58%）、使用说明（51%）和宣传册（34%）。29%的患者在过去两年内未接受HCP检查其吸入器使用是否正确。接受检查的患者依从性显著高于未接受检查的患者（P = 0.020）。使用Breezhaler的大多数患者报告对已服用全剂量非常有信心或有信心，这一比例高于使用Genuair、Ellipta（α = 0.05）和Respimat（α = 0.05）的患者。在过去30天内，Breezhaler的治疗依从性最高，其次是Respimat、Ellipta和Genuair。
REAL调查确定了影响患者依从性和最佳吸入器使用的属性。HCP应了解的影响患者依从性的预测属性包括年龄和疾病严重程度。HCP可以影响的可改变属性包括正确的吸入器使用培训、培训方法的选择、在后续就诊时检查患者的吸入器技术以及装置选择。吸入器是COPD患者有效管理的重要组成部分；因此，患者正确使用吸入器并对剂量充满信心非常重要。
