Inhaler errors are less frequent with ELLIPTA than metered-dose inhalers
Published online: March 2, 2019
The main approach taken for contemporary asthma management is the use of daily controller medications provided by inhalers. Several inhaler devices are available for this purpose, the most commonly used of which are dry powder inhalers (DPIs) and metered-dose inhalers (MDIs). Errors made when using inhalers, which lead to reduced delivery of the medications they contain and reduced treatment effect, are common among patients. Studies have previously shown that the rates of critical errors (errors leading to reduced medication delivery) and overall errors (any inhaler errors) are lower with the ELLIPTA DPI when compared with a number of other DPIs and MDIs.
In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, E. Kerwin and colleagues conducted a clinical study that enrolled adult patients with asthma who had been receiving maintenance therapy for at least three months. Participants were randomized to an inhaler comparison group (ELLIPTA vs FLOVENT HFA [MDI-1] or ELLIPTA vs SYMBICORT [MDI-2]) and an inhaler sequence (receipt of ELLITPA then MDI or the opposite sequence). All inhalers contained placebo and each inhaler was used for 28 days.
At the start of each 28-day assessment period, participants read the patient information leaflet for their assigned device and were asked to demonstrate correct use to a present healthcare professional (HCP). If they were unable to demonstrate correct use, they had up to two further attempts to do so with HCP guidance before taking their inhaler home to use as instructed for 28 days. Participants returned to the study site at the end of each assessment period to repeat their demonstration of inhaler use without instruction and any errors were noted. This process was then repeated for the second inhaler in their assigned sequence. The primary objective was to evaluate the proportion of participants who correctly used the ELLITPA inhaler (no errors) compared with both MDIs after 28 days of use. Primary endpoint analysis was based on discordant cases (participants demonstrating correct use of one inhaler but making errors with the other).
Correct use rates were higher with ELLIPTA than with MDI-1 (96% vs 84%) or MDI-2 (98% vs 91%) after 28 days. Among discordant cases, more patients correctly used ELLITPA and made errors with their assigned MDI than correctly used the MDI and made errors with ELLIPTA (87% vs 13% for both comparisons) and this difference was statistically significant in both cases. More participants also made more than one error when using the MDIs than when using ELLIPTA.
This study highlights that inhaler technique can be improved through guidance from HCPs in clinical trial settings. In these settings, the ELLITPA inhaler is associated with higher rates of correct use and lower error rates than the FLOVENT HFA and SYMBICORT MDIs.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.