A Bayesian Framework to Assess the Usability of Dry Powder Inhalers in a Cohort of Asthma Adolescents in Italy

Roberto Walter Dal Negro,Massimiliano Povero

doi:10.3390/children9010028

Abstract

The useability of DPIs (dry powder inhalers) depends on several factors that are influenced by the patients’ subjectivity and objectivity. The short-form global usability score (S-GUS), a specific tool for the quick ranking and comparison in real life of an inhaler’s usability, was used to investigate six of the most prescribed DPIs (Breezhaler, Diskus, Ellipta, Nexthaler, Spiromax, and Turbohaler) in consecutive asthma patients aged <18 years. A Bayesian indirect comparison (IC) was carried out to merge all pairwise comparisons between the six DPIs. Thirty-three subjects participated: eighteen tested Breezhaler, Spiromax, Nexthaler, and Ellipta simultaneously, while fifteen tested Breezhaler, Spiromax, Diskus, and Turbohaler. The estimates of the S-GUS, by the IC model, allowed us to rank the DPIs by their degree of usability: Ellipta, Diskus, and Spiromax were classified as “good to pretty good” (S-GUS > 15), while Spiromax, Turbohaler, and Breezhaler were classified as “insufficient” (S-GUS < 15). The multidomain assessment is recommended in asthma adolescents in order to approximate the effective usability of different DPIs as best as possible. The S-GUS proves particularly suitable in current clinical practice because of the short time required for its use in adolescents.

Highlights

Cohort of Asthma Adolescents inThe adherence to inhalation therapy, together with the personalization of respiratory treatments, have been strongly supported in the last two decades for persistent bronchial asthma needing the long-term use of active drugs, and in subjects prone to insufficient compliance to inhalation, such as the elderly and adolescents [1,2,3].Dry powder inhalers (DPIs) became progressively available as a result of technological engineering [4,5,6]
The multidomain assessment is recommended in asthma adolescents in order to approximate the effective usability of different DPIs as best as possible
About half of the subjects were already familiar with DPIs, while one third had previous experience with metered dose inhalers (MDIs), and 6% had experience with soft mist inhalers (SMIs)

Summary

Introduction

Cohort of Asthma Adolescents inThe adherence to inhalation therapy, together with the personalization of respiratory treatments, have been strongly supported in the last two decades for persistent bronchial asthma needing the long-term use of active drugs, and in subjects prone to insufficient compliance to inhalation, such as the elderly and adolescents [1,2,3].Dry powder inhalers (DPIs) became progressively available as a result of technological engineering [4,5,6]. The adherence to inhalation therapy, together with the personalization of respiratory treatments, have been strongly supported in the last two decades for persistent bronchial asthma needing the long-term use of active drugs, and in subjects prone to insufficient compliance to inhalation, such as the elderly and adolescents [1,2,3]. The factors affecting patient adherence to inhalation treatments via DPIs have been extensively studied. They have been mostly investigated from the point of view of patients, in terms of their preference, acceptance, and satisfaction [10,11,12,13,14,15], while specific studies aimed at assessing the correspondence between patient beliefs, DPI performances, and their effective usability in real life have been episodic [16,17,18]

Methods

Results

Discussion

Conclusion