Dry Powder Inhaler for Maintenance Therapy in Asthma and COPD
Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory disorders associated with significant morbidity and are commonly treated with inhaled therapies. Despite the availability of effective therapies, asthma remains uncontrolled in many patients. COPD is a significant cause of both morbidity and mortality in later life, the burden of which is predicted to increase in aging populations. Suboptimal adherence to maintenance therapies in asthma and COPD increases the burden of these diseases on patients and healthcare systems.
Maintenance therapy, consisting of an inhaled corticosteroid (ICS) alone or in combination with a long-acting β2 agonist (LABA) is recommended for patients whose asthma is uncontrolled on ICS alone. ICS/LABA therapy is recommended for patients with moderate-to-severe COPD and/or history of COPD exacerbation. The inhaler used to deliver maintenance therapies has a recognised effect on the effectiveness of therapy. Patient satisfaction with the inhaler used to deliver their medication, and their competence in its use, have been identified as modifiable factors that may influence adherence to prescribed treatment. In an analysis of data from the 3-year TORCH study in COPD, a significant association was found between low (<80%) adherence, mortality, and COPD-related hospital admission. In asthma, non-adherence to maintenance therapies is common and may be a factor contributing to poor asthma control.
The ICS fluticasone furoate (FF) has been developed as a monotherapy for asthma, and in combination with the LABA vilanterol (VI) as a once-daily inhaled maintenance therapy for asthma and COPD. Currently available ICS/LABA combination therapies require twice-daily dosing. By simplifying the dosing schedule, a shift from twice-daily to once-daily treatment may have a beneficial effect on treatment adherence. However, a range of other factors are hypothesised to contribute to treatment adherence in asthma and COPD. FF/VI is delivered via a new dry powder inhaler (DPI), the ELLIPTA™ DPI. The inhaler is not yet in use in clinical practice and as such has no real-world test experience. In view of the potential effects of the perception of the delivery device on treatment adherence, we considered it to be clinically important to gain a better understanding of patients' attitudes towards the ELLIPTA DPI.
To this end, an exploratory, qualitative study was performed in a subset of patients with asthma and COPD who participated in phase III trials of FF/VI or FF monotherapy and were subsequently interviewed about their experience of using the ELLIPTA device. Through conducting this study using an inductive methodology, we aimed to identify any hitherto unanticipated patient-perceived issues with the ELLIPTA DPI, and to gain an understanding of the circumstances under which those issues arose. We also sought information around patients' thoughts on specific attributes of the inhaler and comparative preference relative to currently-prescribed alternative inhalers.
Background
Asthma and chronic obstructive pulmonary disease (COPD) are chronic respiratory disorders associated with significant morbidity and are commonly treated with inhaled therapies. Despite the availability of effective therapies, asthma remains uncontrolled in many patients. COPD is a significant cause of both morbidity and mortality in later life, the burden of which is predicted to increase in aging populations. Suboptimal adherence to maintenance therapies in asthma and COPD increases the burden of these diseases on patients and healthcare systems.
Maintenance therapy, consisting of an inhaled corticosteroid (ICS) alone or in combination with a long-acting β2 agonist (LABA) is recommended for patients whose asthma is uncontrolled on ICS alone. ICS/LABA therapy is recommended for patients with moderate-to-severe COPD and/or history of COPD exacerbation. The inhaler used to deliver maintenance therapies has a recognised effect on the effectiveness of therapy. Patient satisfaction with the inhaler used to deliver their medication, and their competence in its use, have been identified as modifiable factors that may influence adherence to prescribed treatment. In an analysis of data from the 3-year TORCH study in COPD, a significant association was found between low (<80%) adherence, mortality, and COPD-related hospital admission. In asthma, non-adherence to maintenance therapies is common and may be a factor contributing to poor asthma control.
The ICS fluticasone furoate (FF) has been developed as a monotherapy for asthma, and in combination with the LABA vilanterol (VI) as a once-daily inhaled maintenance therapy for asthma and COPD. Currently available ICS/LABA combination therapies require twice-daily dosing. By simplifying the dosing schedule, a shift from twice-daily to once-daily treatment may have a beneficial effect on treatment adherence. However, a range of other factors are hypothesised to contribute to treatment adherence in asthma and COPD. FF/VI is delivered via a new dry powder inhaler (DPI), the ELLIPTA™ DPI. The inhaler is not yet in use in clinical practice and as such has no real-world test experience. In view of the potential effects of the perception of the delivery device on treatment adherence, we considered it to be clinically important to gain a better understanding of patients' attitudes towards the ELLIPTA DPI.
To this end, an exploratory, qualitative study was performed in a subset of patients with asthma and COPD who participated in phase III trials of FF/VI or FF monotherapy and were subsequently interviewed about their experience of using the ELLIPTA device. Through conducting this study using an inductive methodology, we aimed to identify any hitherto unanticipated patient-perceived issues with the ELLIPTA DPI, and to gain an understanding of the circumstances under which those issues arose. We also sought information around patients' thoughts on specific attributes of the inhaler and comparative preference relative to currently-prescribed alternative inhalers.
Source...