Ding Bo, Small Mark, Scheffel Gina, Holmgren Ulf
Medical Evidence and Observational Research, AstraZeneca Gothenburg, Mölndal, Sweden.
Real World Research (Respiratory), Adelphi Real World, Bollington, UK.
Int J Chron Obstruct Pulmon Dis. 2018 Mar 16;13:927-936. doi: 10.2147/COPD.S154525. eCollection 2018.
In respiratory disorders, patient- and physician-perceived satisfaction with the maintenance inhaler device is an important factor driving treatment compliance and outcomes. We examine inhaler preferences in asthma and COPD from patient and physician perspectives, particularly focusing on the relative importance of individual device attributes and patient characteristics guiding inhaler choice.
Real-world data from >7,300 patients with asthma, COPD, or asthma-COPD overlap syndrome (ACOS) consulting for routine care were derived from respiratory Disease Specific Programs conducted in Europe, USA, Japan, and China. Outcome variables included current pattern of inhaled maintenance therapy and device type, physician preference, patient-reported device attribute importance, and satisfaction.
The most commonly prescribed inhalers for maintenance therapy of asthma, COPD, and ACOS were dry powder inhalers (62.8%-88.5% of patients) and pressurized metered dose inhalers (18.9%-35.3% of patients). One-third of physicians stated no preference for maintenance device when prescribing treatment, and less than one-third of patients reported being "extremely satisfied" with any attribute of their device. Instructions being "simple and easy to follow" was the inhaler attribute most commonly selected as important. For approximately one-third of patients across all groups, "ease of use/suitability of inhaler device" was a reason for the prescribing decision, as stated by the physician. Device characteristics were more likely to impact the prescribing decision in older patients (in asthma and COPD; <0.01) and those with worse disease severity (in COPD; <0.001).
A relatively high proportion of physicians had no preference for inhaler type across asthma, COPD, and ACOS. Simplicity of use was the most important inhaler attribute from a patient's perspective. Physicians appeared to place most importance on ease of use and device suitability when selecting inhalers for older patients and those with more severe disease, particularly in COPD.
在呼吸系统疾病中，患者和医生对维持治疗吸入装置的满意度是影响治疗依从性和治疗效果的重要因素。我们从患者和医生的角度研究哮喘和慢性阻塞性肺疾病（COPD）患者对吸入装置的偏好，特别关注影响吸入装置选择的各个装置属性和患者特征的相对重要性。
来自欧洲、美国、日本和中国开展的呼吸系统疾病专项项目的超过7300例哮喘、COPD或哮喘-COPD重叠综合征（ACOS）患者的真实世界数据，这些患者因常规护理前来咨询。结果变量包括当前吸入维持治疗模式和装置类型、医生偏好、患者报告的装置属性重要性以及满意度。
用于哮喘、COPD和ACOS维持治疗最常处方的吸入器是干粉吸入器（占患者的62.8%-88.5%）和压力定量吸入器（占患者的18.9%-35.3%）。三分之一的医生在开处方时表示对维持治疗装置没有偏好，不到三分之一的患者表示对其装置的任何属性“极其满意”。“简单易懂”是最常被认为重要的吸入器属性。在所有组中，约三分之一的患者表示，医生称“吸入器装置使用方便/适用性好”是开处方的一个原因。在老年患者（哮喘和COPD患者；P<0.01）和疾病严重程度较差的患者（COPD患者；P<0.001）中，装置特征更有可能影响处方决定。
在哮喘、COPD和ACOS患者中，相当一部分医生对吸入器类型没有偏好。从患者角度来看，使用简便性是最重要的吸入器属性。在为老年患者和病情更严重的患者选择吸入器时，医生似乎最看重使用方便性和装置适用性，尤其是在COPD患者中。
