Inhaler Devices in a Geriatric Patient Population: A Prospective Cross-Sectional Study on Patient Preferences

Purpose: The aim of this study was to examine the perception and preference of geriatric patients for commonly used inhaler devices in Germany. Patients and Methods: This was a prospective, open-label cross-sectional study with inpatient inhaler-naive geriatric volunteers (age >= 70 years). All 106 participants were interviewed and subjected to a geriatric examination for cognitive, motor and fine motor skills before demonstrating the use of nine inhalers in random order. For each device, patients were asked to test the handling, to assess the device properties and to name the device that they would most or least prefer. Results: The mean age of the patients was 80.8 years. From a selection of 7 predefined general inhaler attributes, ease of use, discrete handling and inhalation resistance were the most important for the geriatric participants. Across all inhaler devices, the volunteers needed an average of 2.47 attempts to error-free use. The device with the lowest mean number of attempts was the Nexthaler (R) (1.75; SD +/- 0.903), followed by Spiromax (R) (1.96; SD +/- 0.965) and Genuair (R) (2.05; SD +/- 1.027). There was a weak to moderate correlation between the number of attempts required to ensure the correct use of these three inhalers and the patient's cognitive and fine motor skills. Fifty-nine patients (56%) chose the Nexthaler as the inhalation device that they would most prefer (p<0.001 vs other devices). This was followed by Spiromax (n=23; 22%) and Genuair (n=12; 11%). The device that was least favored was the Elpenhaler (R) (p<0.001 vs other devices). Conclusion: Patient preference and frequency of inhaler handling-errors may vary between inhaler devices. The Nexthaler was the easiest-to-use and most popular device among inhaler-naive patients.