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Respir Med. 2014 Feb;108(2):358-65. doi: 10.1016/j.rmed.2013.09.021. Epub 2013 Oct 2.

Impact of patients' satisfaction with their inhalers on treatment compliance and health status in COPD.

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Division of Pharmacy and Pharmaceutical Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK. Electronic address:
Adelphi Real World, Adelphi Mill, Grimshaw Lane, Macclesfield SK10 5JB, UK.
Almirall, Sant Feliu R&D Centre, Laureà-Miró, 408-410, 08980 Sant Feliu de Llobregat, Barcelona, Spain.
Almirall, Ronda General Mitre, 151, 08022 Barcelona, Spain.



To examine the relationships between inhaler satisfaction, treatment compliance and health status in patients with chronic obstructive pulmonary disease (COPD).


In a large, multinational, cross-sectional, real-world survey, respiratory specialists and primary care physicians provided information on six consecutive patients with COPD, who were then asked to complete a questionnaire. Physician-assessed compliance was scored (5-point Likert scale) and patients rated overall satisfaction with their maintenance inhaler (7-point Likert scale). Health status assessments included frequency of exacerbations and hospitalizations due to exacerbations in the past 12 months.


The analysis included 1443 patients (71.8% male; mean age 65.2 years). Patients' overall satisfaction with their inhaler was significantly associated with treatment compliance (χ(2) - df = 89.7; p < 0.001). Male gender (χ(2) - df = 2.9; p < 0.05) and fewer maintenance drugs (χ(2) - df = 17.7; p < 0.001) were also associated with compliance; age and breathlessness severity were not. Attributes influencing inhaler satisfaction mainly related to durability, ergonomics and ease of use. Small but statistically significant associations were observed between increasing treatment compliance and fewer exacerbations (R(2) = 0.037; p < 0.001) and fewer hospitalizations due to exacerbations (R(2) = 0.025; p < 0.001). There was a direct association between inhaler satisfaction and fewer exacerbations (R(2) = 0.03; p < 0.001).


Treatment compliance appears to be modestly associated with inhaler satisfaction, better health status and less frequent COPD exacerbations, although other factors are also likely to be involved. Durability, ergonomics and ease-of-use are inhaler attributes that influence patient satisfaction.


Chronic obstructive pulmonary disease (COPD); Compliance; Exacerbations; Inhaler devices; Satisfaction

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