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Dry Powder Inhalers Compared for Correct Use, Ease of Handling: Breezhaler versus HandiHaler

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Patients with chronic obstructive pulmonary disease (COPD) prefer the Breezhaler single-dose dry powder inhaler over the HandiHaler for continued daily use. Their preference stems from ease of use and confidence that the medication is taken correctly using the Breezhaler, according to a poster presented by Kenneth R. Chapman, MD, MSc, Director, Asthma & Airway Centre, University Health Network, Toronto Western Hospital, Canada.

“These initial impressions, after a relatively short familiarization period, may be important to continued successful use, since a patient may be more adherent when using an inhaler that they like and find easy to use,” Dr Chapman and colleagues observed.

They studied 82 patients (aged ≥40 years) with mild-to-severe COPD and a smoking history of at least 10 pack-years who required treatment with inhaled medication.

Patients were randomized to either the Breezhaler or the HandiHaler with placebo capsules once daily for 7 days in addition to usual treatment and then were switched to the opposite inhaler.

On day 1, patients read written instructions for use of the inhaler and had 30 minutes to practice. Patients’ ability to perform each of the 21 steps required for correct use of the Breez haler, as well as the 19 steps required for the HandiHaler, were recorded by 2 trained assessors. For each device, 2 steps were deemed essential for correct use. Patients then received training and a demonstration of correct device use. They were assessed again on day 7. After the end of the second treatment period, they completed a preference questionnaire.

Most patients completed each handling step for both inhalers correctly after 7 days (78%-100% for Breezhaler; 81%-100% for HandiHaler). For most steps, the proportion of patients correctly performing the step improved from day 1 to day 7.

Patient training had a greater effect on use of the HandiHaler than on use of the Breezhaler, Dr Chapman said. For the critical step of fully releasing the button before inhalation, the Breezhaler score was similarly high on both days (93% and 96%, respectively), whereas the HandiHaler score changed 11 points, from 88% on day 1 to 99% on day 7.

Overall, patients preferred the Breezhaler (61%) over the HandiHaler (31%). The Breezhaler was preferred for ease of opening and closing the cap and mouthpiece, closing the mouthpiece after inserting the capsule, and holding the inhaler during use. It was also preferred for simplicity of use and for confidence in successful intake of the medication.

Last modified: August 30, 2021