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Asthma
Original research
Maintenance inhaler therapy preferences of patients with asthma or chronic obstructive pulmonary disease: a discrete choice experiment
  1. Tommi Tervonen1,2,
  2. Natalia Hawken1,
  3. Nicola A Hanania3,
  4. Fernando J Martinez4,
  5. Sebastian Heidenreich1,
  6. Ileen Gilbert5
  1. 1 Patient-Centered Research, Evidera, London, UK
  2. 2 Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  3. 3 Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
  4. 4 Division of Pulmonary Medicine, Weill-Cornell Medical Center, Cornell University, New York City, New York, USA
  5. 5 AstraZeneca, Wilmington, Delaware, USA
  1. Correspondence to Dr Tommi Tervonen, Patient-Centered Research, Evidera, London W6 8BJ, UK; tommi.tervonen{at}evidera.com

Abstract

Background A variety of maintenance inhaler therapies are available to treat asthma and COPD. Patient-centric treatment choices require understanding patient preferences for the alternative therapies.

Methods A self-completed web-based discrete choice experiment was conducted to elicit patient preferences for inhaler device and medication attributes. Selection of attributes was informed by patient focus groups and literature review.

Results The discrete choice experiment was completed by 810 patients with asthma and 1147 patients with COPD. Patients with asthma most valued decreasing the onset of action from 30 to 5 min, followed by reducing yearly exacerbations from 3 to 1. Patients with COPD most and equally valued decreasing the onset of action from 30 to 5 min and reducing yearly exacerbations from 3 to 1. Both patients with asthma and patients with COPD were willing to accept an additional exacerbation in exchange for a 15 min decrease in onset of action and a longer onset of action in exchange for a lower risk of adverse effects from inhaled corticosteroids. Patients with asthma and COPD valued once-daily over twice-daily dosing, pressurised inhalers over dry powder inhalers and non-capsule priming over single-use capsules, although these attributes were not valued as highly as faster onset of action or reduced exacerbations.

Conclusions The most important maintenance inhaler attributes for patients with asthma and COPD were fast onset of symptom relief and a lower rate of exacerbations. Concerns about safety of inhaled corticosteroids and device convenience also affected patient preferences but were less important.

  • asthma
  • COPD exacerbations
  • inhaler devices
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/thoraxjnl-2019-213974

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    Footnotes

    • Contributors TT participated in design, planning, conduct, conception and design of the study and in design, analysis and interpretation of data. SH participated in reporting, analysis and interpretation of data. IG participated in planning, conception, design and conduct of the study and in reporting and interpretation of data. NH participated in planning, conduct, design and conception of the study and reporting of data. FJM and NAH participated in conception and design of the study and interpretation of data. In addition, all authors wrote, edited or provided significant comments on the manuscript; approved the final version of the manuscript and agreed to be accountable for the manuscript’s contents. TT takes responsibility for the content of the manuscript, included the data and analysis.

    • Funding AstraZeneca

    • Competing interests IG is an employee of AstraZeneca, the study sponsor. TT, NH and SH are employees of Evidera, which was contracted by AstraZeneca to complete work related to this study. NAH has received honoraria for serving as an advisor/consultant and research funds (to his institution) from AstraZeneca. FJM reports personal fees from Adept, Afferent, Amgen, AstraZeneca, Axon, Axon Communication, Boehringer Ingelheim, Clarion, ConCert, Forest, Genentech, GlaxoSmithKline, Ikaria/Bellerophon, Informa, Janssen, Kadmon, Lucid, Methodist Hospital, Novartis, Nycomed/Takeda, Pearl Therapeutics, Pfizer, Prime, Roche, Sunovion, Theravance, Unity Biotechnology, Veracyte and WebMD; royalty fees from Informa and has spoken on behalf of AstraZeneca and Nycomed/Takeda.

    • Patient consent for publication Not required.

    • Ethics approval Advarra Institutional Review Board (Columbia, MD, USA) granted exemption from institutional review board oversight based on Department of Health and Human Services regulations. All participants provided written informed consent in all study phases.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. Data not available as no consent was sought from patients to allow sharing of data with third parties.

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