Background and aims Patient preference and satisfaction with inhalers are important factors that may impact adherence to treatment and hence its outcome.1 The ADVANTAGE study compared the Breezhaler® and the Ellipta® inhalers for patient perception of feedback mechanism and the comfort of the mouth piece, in COPD patients, naïve to dry powder inhaler use.
Methods This open-label cross-over study randomised (1:1) patients (≥40 years) with COPD [all severities as per GOLD 2014] and smoking history of ≥10 pack-years to use both the Breezhaler® and Ellipta® devices in differing sequences with a separation of ≥5 minutes between devices. After inhalation, patients completed a questionnaire2 containing 4 questions that captured patients’ perception of the feedback mechanism (mean of first three questions) and comfort of the mouth piece (fourth question). Questions were answered on a scale of 1 (lower preference) to 5 (higher preference), a Wilcoxon signed rank test was performed to test the difference between devices at a 2-sided 2.5% level of significance for both endpoints. Safety assessments included adverse events, physical examination, vital signs, height and weight.
Results One hundred patients (64 men and 36 women) with a mean (SD) age of 65.2 (9.07) years were randomised to inhale sequentially through both devices. Thirty two patients were current smokers and had a mean (SD) duration of COPD for 6.1 (4.82) years. Overall, patients perceived that the Breezhaler® inhaler offered greater confidence of dose delivery and better comfort of the mouth piece (mean (SD) score 4.3 (0.70) and 4.3 (0.82); respectively) vs. the Ellipta® inhaler [mean (SD) score 3.6 (1.05) and 3.9 (0.84); respectively] (Figure). No safety signals were identified during the study.
Conclusions In this study, COPD patients had greater confidence of receiving full dose with the Breezhaler® device and better comfort with the mouth piece compared with the Ellipta® device.