Patients with chronic obstructive pulmonary disease (COPD) who switched to single-inhaler extra-fine triple therapy from dual- or multiple-inhaler triple therapy improved their inhalation technique and adherence after receiving inhalation technique training, according to study findings published in Respiratory Medicine.
Investigators sought to determine whether patients with COPD who switched from dual- or multiple-inhaler therapy to single inhaler extra-fine triple therapy (ie, Trimbow delivered via a pressurized metered-dose inhaler [pMDI]) and received inhalation technique training experienced changes in treatment adherence, inhalation technique, and outcome. Primary outcomes of interest included lung function, symptom score, patient satisfaction, and exacerbations. Inhalation technique training specifically included teach-back training by health care professionals on the use of a pressurized metered dose inhaler with triple therapy.
Investigators conducted a noninterventional, multi-center, single arm, phase IV study that included 126 patients (at least 40 years of age, mean [SD] age, 66.2 [8.2] years; 32.5% female) with moderate-to-severe COPD in the per protocol population, recruited from June 2018 through September 2019. Patients previously treated with dual therapy or multiple inhaler triple therapy were switched to single inhaler extra-fine triple therapy (beclomethasone dipropionate [BDP, 87µg], formoterol fumarate [FF, 5µg] and glycopyrronium [G, 9µg]; 2 inhalations twice daily) and received inhalation technique training; they were then assessed for inhalation technique and treatment adherence at visit 1 (baseline), visit 2 (1-5 months), and visit 3 (5-12 months). Investigators noted patients were treated at 1 of the participating sites in Belgium after the commercial launch of Trimbow.
Overall, 10 patients were lost to follow-up, 18 patients discontinued intervention (10 with adverse events [AEs], 8 with special situations), 3 patients withdrew consent, and 6 patients died during the course of the study (notably no deaths were causally related to study treatment).
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[I]n eligible COPD patients in a real-life setting, the switch from dual therapy or multiple inhaler triple therapy to single inhaler extra-fine BDP/FF/G in combination with inhalation technique training is associated with improved inhalation technique and adherence.
Device errors were detected among 28.8% of patients and critical errors were detected among 9.6% of patients at baseline (ie, before switching to single inhaler extra-fine BDP/FF/G). After patients switched, device errors decreased at the visit-2 follow-up, being present in only 14.0% of patients, with 0 critical errors noted; at the visit-3 follow-up, 16.3% of patients had device errors, with 0 critical errors noted, and improvement was noted in inhalation technique. Treatment adherence (67.5% at visit-1) improved to 75.8% at the visit-2 follow-up and to 80.0% at the visit-3 follow-up.
Investigators noted that the enhanced inhalation technique was associated with a significant decrease in exacerbation rates and increased lung function, symptom, and patient satisfaction scores.
In citing study limitations, the investigators noted that the vast majority of study participants had previously been treated with multiple inhaler triple therapy. Additionally, the study lacked a control arm.
Investigators concluded, “This observational study demonstrates that in eligible COPD patients in a real-life setting, the switch from dual therapy or multiple inhaler triple therapy to single inhaler extra-fine BDP/FF/G in combination with inhalation technique training is associated with improved inhalation technique and adherence.” They further noted that “lung function, symptom and patient satisfaction scores improved, whilst exacerbation rates substantially decreased after initiation of single inhaler extra-fine BDP/FF/G.”
Disclosure: This research was supported by Chiesi sa/nv. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
