Patient perception of Breezhaler<sup>®</sup> and Ellipta<sup>®</sup> device feedback mechanisms in COPD: The ADVANTAGE Study

<p><b>Objectives:</b> The primary objective of the ADVANTAGE study was to compare device-naïve chronic obstructive pulmonary disease (COPD) patients’ perception of the Breezhaler<sup>®</sup> and Ellipta<sup>®</sup> devices’ feedback mechanisms of dose delivery confirmation. The secondary objective was to assess comfort with the inhalers’ mouthpiece in terms of ease to form a tight seal around the mouthpiece. These objectives were achieved by using a novel, patient perception of inhaler questionnaire developed and tested during cognitive interviews of patients by Evidera, London, United Kingdom.</p> <p><b>Methods:</b> Ten COPD patients were interviewed to collect feedback on the interpretation, relevance and language of the questionnaire. This questionnaire was then used in ADVANTAGE to compare patients’ perception (<i>n</i> = 100) of both devices. Patients completed the questionnaire after a single inhalation of placebo through each inhaler.</p> <p><b>Results:</b> Using the final questionnaire, patients reported being more confident of the feedback mechanism of Breezhaler than that of the Ellipta device (mean score 4.3 versus 3.6 respectively, estimated difference [95% CI]: 0.75 [0.51, 0.99], <i>p</i> < .0001). Patients also reported better comfort (ease to form a tight seal with the lips) with the Breezhaler mouthpiece than the Ellipta mouthpiece (mean score 4.3 versus 3.9 respectively, estimated difference [95% CI]: 0.41 [0.21, 0.61], <i>p</i> < .0001). There were no safety concerns associated with either device.</p> <p><b>Conclusion:</b> COPD patients showed greater preference for the Breezhaler over the Ellipta inhaler for confidence of dose delivery and comfort of the mouthpiece.</p> <p><b>Trial registration:</b> The trial is registered at ( number NCT02551224).</p>