COPD patient satisfaction with ipratropium bromide/albuterol delivered via Respimat: a randomized, controlled study

Gary T Ferguson, Mo Ghafouri, Luyan Dai, Leonard J Dunn, Gary T Ferguson, Mo Ghafouri, Luyan Dai, Leonard J Dunn

Abstract

Background: Ipratropium bromide/albuterol Respimat inhaler (CVT-R) was developed as an environmentally friendly alternative to ipratropium bromide/albuterol metered-dose inhaler (CVT-MDI), which uses a chlorofluorocarbon propellant.

Objective: The objective of this study was to evaluate patient satisfaction, device usage, and long-term safety of CVT-R compared to CVT-MDI, and to the simultaneous administration of ipratropium bromide hydrofluoroalkane (HFA; I) and albuterol HFA (A) metered-dose inhalers as dual monotherapies (I + A).

Design: This is a 48-week, open-label, randomized, active-controlled, parallel-group study (n = 470) comparing CVT-R to CVT-MDI and to I + A.

Participants: Patients were at least 40 years of age, diagnosed with chronic obstructive pulmonary disease (COPD), and current or exsmokers.

Interventions: Patients were randomized to receive: (1) CVT-R, one inhalation four times daily (QID); or (2) CVT-MDI, two inhalations QID; or (3) I + A two inhalations of each inhaler QID.

Main measures: Patient Satisfaction and Preference Questionnaire (PASAPQ) performance score (primary endpoint) and adverse events.

Key results: PASAPQ performance score was significantly higher (CVT-R versus CVT-MDI, 9.6; and CVT-R versus I + A, 6.2; both P < 0.001) when using CVT-R compared to CVT-MDI or I + A at all visits starting from week 3, while CVT-MDI and I + A treatment groups were similar. Time to first COPD exacerbation was slightly longer in the CVT-R group compared to the other treatment groups, although it did not reach statistical significance (CVT-R versus CVT-MDI, P = 0.57; CVT-R versus I + A, P = 0.22). Rates of withdrawal and patient refusal to continue treatment were lower in CVT-R compared with CVT-MDI and I + A groups (CVT-R versus CVT-MDI, P = 0.09; CVT-R versus I + A, P = 0.005). The percentage of patients reporting adverse events and serious adverse events was similar across all three treatment groups.

Conclusion: CVT-R is an effective, environmentally friendly inhaler that provides patients with a high level of user satisfaction and may positively impact clinical outcomes while having no adverse impacts on patients using the device.

Trial registration: ClinicalTrials.gov NCT01019694.

Keywords: COPD; consumer preference; consumer satisfaction; inhalers.

Figures

Figure 1
Figure 1
Study population. Notes: Five randomized patients did not proceed with treatment: three patients decided to not participate, one patient developed a COPD exacerbation, and one patient was unable to stop prohibited medication prior to randomization. Abbreviations: N, number; CVT-R, ipratropium bromide/albuterol Respimat inhaler; CVT-MDI, ipratropium bromide/albuterol metered-dose inhaler; I+A, ipratropium bromide and albuterol metered dose inhalers delivered as dual monotherapies; AE, adverse event.
Figure 2
Figure 2
Kaplan–Meier curves of time to discontinuation. Abbreviations: CVT-R, ipratropium bromide/albuterol Respimat inhaler; CVT-MDI, ipratropium bromide/albuterol metered-dose inhaler; I + A, ipratropium bromide and albuterol metered dose inhalers delivered as dual monotherapies; d, days.
Figure 3
Figure 3
Adjusted mean of PASAPQ performance domain score time profile. Abbreviations: PASAPQ, Patient Satisfaction and Preference Questionnaire; CVT-R, ipratropium bromide/albuterol Respimat inhaler; CVT-MDI, ipratropium bromide/albuterol metered-dose inhaler; I + A, ipratropium bromide and albuterol metered dose inhalers delivered as dual monotherapies.
Figure 4
Figure 4
Kaplan-Meier curves for time to first COPD exacerbation. Abbreviations: COPD, chronic obstructive pulmonary disease; CVT-R, ipratropium bromide/albuterol Respimat inhaler; CVT-MDI, ipratropium bromide/albuterol metered-dose inhaler; I+A, ipratropium bromide and albuterol metered dose inhalers delivered as dual monotherapies; d, day.

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