Introduction and objectives Shared decision-making for drug and inhaler-device use improves adherence and outcomes in COPD. Physicians are encouraged to involve patient’s opinion in choosing drugs and inhalers. It remains unclear, however, whether the superior effect on FEV1 shown for the fixed-dose combination of indacaterol/glycopyrronium (IND/GLY) compared to tiotropium (TIO) translates into medication preference by patients.

The present study was conducted to evaluate the overall preference for IND/GLY and TIO respectively, in patients who are still symptomatic under a TIO treatment.

Method This multicenter, cross-over, open-label study randomised COPD patients with moderate to severe airflow limitation and a CAT score of ≥10 to either receive 4 weeks o.d. IND/GLY (110/50 µg) followed by 4 weeks o.d. TIO (18 µg) or vice versa in a 1:1 ratio. To determine patient’s treatment preference and satisfaction as secondary and explorative objectives, respectively, several validated and new questionnaires were used. As primary endpoint, FEV1 1 h post-inhalation after 4 weeks was investigated.

Results Of 88 patients (mean age, 65 years; post-bronchodilator FEV1, 57.7% predicted; mean CAT score, 17.6) randomised, 87 patients completed the study. After 4 weeks treatment, 1 h post-inhalation FEV1 was significantly higher with IND/GLY compared to TIO (LSM difference, 81 ml; p = 0.0017). Importantly, a higher proportion of patients preferred IND/GLY (69.4%) over TIO (30.6%) at the end of the study. Reduction of dyspnea was mentioned as an important or very important reason for favouring IND/GLY by 91.5% of the patients.

Conclusion This study indicated that beyond FEV1, patients reported outcomes improve with the dual bronchodilator IND/GLY compared to TIO monotherapy. Further studies are needed to investigate how the favoured treatment option translates into improved adherence and long term treatment outcomes.