Skip to main content
Log in

Development and Validation of a Patient Satisfaction and Preference Questionnaire for Inhalation Devices

  • Original Research Article
  • Published:
Treatments in Respiratory Medicine

Abstract

Introduction

The Patient Satisfaction and Preference Questionnaire (PASAPQ) is a multi-item measure of respiratory inhalation device satisfaction and preference designed to be easily understood and administered to patients with asthma and COPD. This study assessed its validity, reliability and responsiveness and explored the between-group difference in PASAPQ scores that is meaningful.

Methods

The field test version was developed using literature, focus groups and expert opinion. Item reduction followed. The assessment of the validity, reliability and responsiveness of the PASAPQ utilized data from two clinical studies comparing devices delivering the same medication, and was performed with pre-specified criteria. A minimally important difference (MID) was estimated using both anchor- and distribution-based approaches.

Results

Two factors of the PASAPQ, ‘performance’ and ‘convenience’, were consistent across studies. Missing and out-of-range data were minimal (<1%) and respondents used a full range of response options. All items correlated most highly with their hypothesized scale and all exceeded the minimum correlation criteria of 0.40. Cronbach’s alfa was high (0.87–0.94), providing support for internal reliability for the PASAPQ. Correlations of the overall satisfaction item with the performance domain ranged from 0.78 to 0.91, the convenience domain ranged from 0.54 to 0.71, and the total score ranged from 0.78 to 0.90. These moderate-to-strong correlations provide substantial support for the validity of the PASAPQ domains and total score. Discriminate validity was assessed by calculating PASAPQ scores for patients’ ratings of the device that they preferred compared with the other, non-preferred device. The preferred device was rated higher on all satisfaction measures, supporting the ability of the PASAPQ to discriminate between preferred and non-preferred devices. Although a difference of 3 or 4 points may be sufficient to observe a small effect difference between groups, most of the MID estimates were in the 8–10 point range.

Discussion and conclusion

Our analyses across asthma, COPD and patients with mixed respiratory disease (with features of both COPD and asthma), study designs and data sets lead us to conclude that the PASAPQ is a practical, valid, reliable and responsive instrument for measuring respiratory device satisfaction. Furthermore, a difference in satisfaction scores between treatment groups of 10 points is, conservatively, a difference that is meaningful to patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Table I
Table II
Table III
Table IV
Table V
Table VI
Table VII

Similar content being viewed by others

Notes

  1. 1 The use of trade names is for product identification purposes only and does not imply endorsement.

References

  1. Duerden M, Price D. Training issues in the use of inhalers. Dis Manage Health Outcomes 2001; 9: 75–87

    Article  Google Scholar 

  2. Pavia D. Efficacy and safety of inhalation therapy in chronic obstructive pulmonary disease and asthma. Respirology 1997; 2Suppl. 1: S5–10

    PubMed  Google Scholar 

  3. Ganderton D. Targeted delivery of inhaled drugs: current challenges and future goals. J Aerosol Med 1999; 12Suppl. 1: S3–8

    PubMed  Google Scholar 

  4. Lotvall J, O’Byrne P. Targeting drugs to the airways by different inhalation devices. BioDrugs 1999; 12: 279–89

    Article  PubMed  CAS  Google Scholar 

  5. Geller DE. New liquid aerosol generation devices: systems that force pressurized liquids through nozzles. Respir Care 2002; 47: 1392–404

    PubMed  Google Scholar 

  6. Newman SP, Brown J, Steed KP, et al. Lung deposition of fenoterol and flunisolide delivered using a novel device for inhaled medicines: comparison of Respimat with conventional metered-dose inhalers with and without spacer devices. Chest 1998; 113: 957–63

    Article  PubMed  CAS  Google Scholar 

  7. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J 2002; 19: 246–51

    Article  PubMed  CAS  Google Scholar 

  8. Atkinson MJ, Sinha A, Hass SL, et al. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes 2004; 2: 12

    Article  PubMed  Google Scholar 

  9. Shikiar R, Rentz AM. Satisfaction with medication: an overview of conceptual, methodologic, and regulatory issues. Value Health 2004; 7: 204–15

    Article  PubMed  Google Scholar 

  10. Boe J, Stiksa G, Svensson K, et al. New method of evaluating patient preference for different inhalation delivery systems. Ann Allergy 1992; 68: 255–60

    PubMed  CAS  Google Scholar 

  11. Schlaeppi M, Edwards K, Fuller RW, et al. Patient perception of the Diskus inhaler: a comparison with the Turbuhaler inhaler. Br J Clin Pract 1996; 50: 14–9

    PubMed  CAS  Google Scholar 

  12. Nielsen K, Okamoto L, Shah T. Importance of selected inhaler characteristics and acceptance of a new breath-actuated powder inhalation device. J Asthma 1997; 34: 249–53

    Article  PubMed  CAS  Google Scholar 

  13. Mahajan P, Okamoto L. Patient satisfaction with the Diskhaler and the Diskus inhaler, a new multidose power delivery system for the treatment of asthma. Clin Ther 1997; 19: 1126–34

    Article  PubMed  CAS  Google Scholar 

  14. van der Palen J, Klein JJ, Schildkamp AM. Comparison of a new multidose powder inhaler (Diskus/Accuhaler) and the Turbuhaler regarding preference and ease of use. J Asthma 1998; 35: 147–52

    Article  PubMed  Google Scholar 

  15. Liam CK, Lim KH, Wong CM. Acceptance of the Accuhaler, a multi-dose powder inhaler, among asthmatic patients: a comparison with the pressurized metered-dose inhaler. Asian Pac J Allergy Immunol 2000; 18: 135–40

    PubMed  CAS  Google Scholar 

  16. Brown PH, Lenney J, Armstrong S, et al. Breath-actuated inhalers in chronic asthma: comparison of Diskhaler and Turbohaler for delivery of beta-agonists. Eur Respir J 1992; 5: 1143–5

    PubMed  CAS  Google Scholar 

  17. Bronsky EA, Debelic M, Pujet JC, et al. Ease-of-use study of pirbuterol acetate in the Autohaler actuator in three countries: the United States, Germany, and France. J Asthma 1993; 30: 439–43

    Article  PubMed  CAS  Google Scholar 

  18. Chapman KR, Love L, Brubaker H. A comparison of breath-actuated and conventional metered-dose inhaler inhalation techniques in elderly subjects. Chest 1993; 104: 1332–7

    Article  PubMed  CAS  Google Scholar 

  19. Kesten S, Elias M, Cartier A, et al. Patient handling of a multidose dry powder inhalation device for albuterol. Chest 1994; 105: 1077–81

    Article  PubMed  CAS  Google Scholar 

  20. Boulet LP, Cowie R, Johnston P, et al. Comparison of Diskus inhaler, a new multidose powder inhaler, with Diskhaler inhaler for the delivery of salmeterol to asthmatic patients. Canadian Study Group. J Asthma 1995; 32: 429–36

    Article  PubMed  CAS  Google Scholar 

  21. Gioulekas D, Papakosta D, Vordoyianni P, et al. A comparison of the clinical efficacy and patient acceptability of terbutaline Turbuhaler and salbutamol Rotahaler, in adult patients with asthma. Respir Med 1996; 90: 205–9

    Article  PubMed  CAS  Google Scholar 

  22. O’Reilly JF, Weir DC, Banham S, et al. Is high-dose fluticasone propionate via a metered-dose inhaler and Volumatic as efficacious as nebulized budesonide in adult asthmatics? Respir Med 1998; 92: 111–7

    Article  PubMed  Google Scholar 

  23. Pieters WR, Stallaert RA, Prins J, et al. A study on the clinical equivalence and patient preference of fluticasone propionate 250 microgram twice daily via the Diskus/Accuhaler inhaler or the Diskhaler inhaler in adult asthmatic patients. J Asthma 1998; 35: 337–45

    Article  PubMed  CAS  Google Scholar 

  24. Balzano G, Battiloro R, Biraghi M, et al. Effectiveness and acceptability of a domiciliary multidrug inhalation treatment in elderly patients with chronic airflow obstruction: metered dose inhaler versus jet nebulizer. J Aerosol Med 2000; 13: 25–33

    Article  PubMed  CAS  Google Scholar 

  25. Kunkel G, Schaper C, Noga O, et al. Efficacy, safety, and acceptance of beclomethasone dipropionate administered via a new dry powder inhaler or a standard CFC metered-dose inhaler in asthma patients. Respiration 2003; 70: 399–406

    Article  PubMed  CAS  Google Scholar 

  26. Frew AJ, Langley SJ, Perrin V, et al. Effects of 4-week treatment with low-dose budesonide (100 micrograms BID) from a novel inhaler Airmax and from a conventional inhaler on bronchial hyper-responsiveness, lung function and symptoms in patients with mild asthma. Respir Med 2002; 96: 542–7

    Article  PubMed  CAS  Google Scholar 

  27. Tukiainen H, Rytila P, Hamalainen KM, et al. Safety, tolerability and acceptability of two dry powder inhalers in the administration of budesonide in steroid-treated asthmatic patients. Respir Med 2002; 96: 221–9

    Article  PubMed  CAS  Google Scholar 

  28. Jager L, Laurikainen K, Leinonen M, et al. Beclomethasone dipropionate Easyhaler is as effective as budesonide Turbohaler in the control of asthma and is preferred by patients. German Study Group. Int J Clin Pract 2000; 54: 368–72

    PubMed  CAS  Google Scholar 

  29. Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol 2003; 56: 395–407

    Article  PubMed  Google Scholar 

  30. Schürmann W, Schmidtmann S, Moroni P, et al. Respimat® Soft Mist™ inhaler versus hydrofluoroalkane metered dose inhaler: patient preference and satisfaction. Treat Respir Med 2005; 4(1): 53–61

    Article  PubMed  Google Scholar 

  31. Ware J, Harris W, Gandek B, et al. MAP-R for Windows. Multitrait/multi-item analysis program: revised user’s guide. Boston (MA): Health Assessment Lab., 1997

    Google Scholar 

  32. Hand CH. Developing a questionnaire to measure patients’ beliefs about inhaler treatment: a pilot study. Asthma Gen Pract 1998; 6: 40–3

    Google Scholar 

  33. Williams J, Richards KA. Ease of handling and clinical efficacy of fluticasone propionate Accuhaler/Diskus inhaler compared with the Turbohaler inhaler in paediatric patients. Br J Clin Pract 1997; 51: 147–53

    PubMed  CAS  Google Scholar 

  34. Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 1994; 47: 81–7

    Article  PubMed  CAS  Google Scholar 

  35. Guyatt GH, Osoba D, Wu AW, et al. Methods to explain the clinical significance of health status measures. Mayo Clin Proc 2002; 77: 371–83

    Article  PubMed  Google Scholar 

  36. Kelleher CJ, Pleil AM, Reese PR, et al. How much is enough and who says so? BJOG 2004; 111: 605–12

    Article  PubMed  Google Scholar 

  37. Wyrwich KW, Nienaber NA, Tierney WM, et al. Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Med Care 1999; 37: 469–78

    Article  PubMed  CAS  Google Scholar 

  38. Novak A, de la Loge C, Abetz L. Development and validation of an acceptability and satisfaction questionnaire for a contraceptive vaginal ring, NuvaRing. Pharmacoeconomics 2004; 22: 245–56

    Article  PubMed  Google Scholar 

  39. Welch MJ, Nelson HS, Shapiro G, et al. Comparison of patient preference and ease of teaching inhaler technique for Pulmicort Turbuhaler versus pressurized metered-dose inhalers. J Aerosol Med 2004; 17: 129–39

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The study was funded by Boehringer Ingelheim GmbH. B. Monz is an employee of Boehringer Ingelheim GmbH. C. Kozma, T. Slaton, and P. Reese worked as consultants for Boehringer Ingelheim on this project. R. Hodder was clinical investigator of one of the clinical studies that was funded by Boehringer Ingelheim.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brigitta U. Monz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kozma, C.M., Slaton, T.L., Monz, B.U. et al. Development and Validation of a Patient Satisfaction and Preference Questionnaire for Inhalation Devices. Treat Respir Med 4, 41–52 (2005). https://doi.org/10.2165/00151829-200504010-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00151829-200504010-00005

Keywords

Navigation