World Health Organization (WHO). Chronic diseases and their common risk factors. https://apps.who.int/iris/handle/10665/43314. Accessed 20 Dec 2021.

GINA. GINA main report - Global Initiative for Asthma - GINA. Updated 2021. https://ginasthma.org/gina-reports/. Accessed 20 Dec 2021.

GOLD. Global strategy for prevention, diagnosis and management of COPD. 2022. https://goldcopd.org/2022-gold-reports-2/. Accessed 20 Dec 021.

Chrystyn H, Lavorini F. The dry powder inhaler features of the Easyhaler that benefit the management of patients. Expert Rev Respir Med. 2020;14(4):345–51.

Article  CAS  Google Scholar 

Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan JHY, et al. Predictive value of control of COPD for risk of exacerbations: an international, prospective study. Respirology. 2020;25(11):1136–43.

Article  Google Scholar 

Price D, Fletcher M, Van Der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014;24.

Levy ML, Carroll W, Izquierdo Alonso JL, Keller C, Lavorini F, et al. Understanding dry powder inhalers: key technical and patient preference attributes. Adv Ther. 2019;36(10):2547–57.

Article  Google Scholar 

AL-Jahdali H, Ahmed A, AL-Harbi A, Khan M, Baharoon S, Bin Salih S, et al. Improper inhaler technique is associated with poor asthma control and frequent emergency department visits. Allergy Asthma Clin Immunol. 2013;9(1).

Crompton GK, Barnes PJ, Broeders M, Corrigan C, Corbetta L, Dekhuijzen R, et al. The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team. Respir Med. 2006;100(9):1479–94.

Article  CAS  Google Scholar 

Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481–90.

Article  Google Scholar 

Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M, Martucci P, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–8.

Article  Google Scholar 

Gregoriano C, Dieterle T, Breitenstein AL, Dürr S, Baum A, Maier S, et al. Use and inhalation technique of inhaled medication in patients with asthma and COPD: data from a randomized controlled trial. Respir Res. 2018;19(1):1–15.

Article  CAS  Google Scholar 

Usmani OS, Lavorini F, Marshall J, et al. Critical inhaler errors in asthma and COPD: a systematic review of impact on health outcomes. Respir Res. 2018;19:10. https://doi.org/10.1186/s12931-017-0710-y.

Article  PubMed  PubMed Central  Google Scholar 

Canonica GW, Arp J, Keegstra JR, Chrystyn H. Spiromax, a new dry powder inhaler: dose consistency under simulated real-world conditions. J Aerosol Med Pulm Drug Deliv. 2015;28(5):309–19.

Article  CAS  Google Scholar 

Giner J, Villarnovo Cerrillo M, Aboín Sierra J, Casas Herrero L, Patino O, Plaza V. Assessment of inhalation errors, training time and patient preference for DuoResp® Spiromax® and Symbicort® Turbuhaler® in patients with asthma and COPD. Eur Clin Respir J. 2021;8(1).

Chrystyn H, Safioti G, Keegstra JR, Gopalan G. Effect of inhalation profile and throat geometry on predicted lung deposition of budesonide and formoterol (BF) in COPD: an in-vitro comparison of Spiromax with Turbuhaler. Int J Pharm. 2015;491(1–2):268–76.

Article  CAS  Google Scholar 

Atkins PJ. Dry powder inhalers: an overview - PubMed. Respir Care. 2005;50:1304–12.

PubMed  Google Scholar 

Virchow JC, Crompton GK, Dal Negro R, Pedersen S, Magnan A, Seidenberg J, Barnes PJ. Importance of inhaler devices in the management of airway disease. Respir Med. 2008 Jan;102(1):10–9. https://doi.org/10.1016/j.rmed.2007.07.031.

Haidl P, Heindl S, Siemon K, Bernacka M, Cloes RM. Inhalation device requirements for patients’ inhalation maneuvers. Respir Med. 2016;118:65–75.

Article  Google Scholar 

Gálffy G, Szilasi M, Tamási L. Effectiveness and patient satisfaction with budesonide/formoterol Easyhaler® among patients with asthma or COPD switching from previous treatment: a real-world study of patient-reported outcomes. Pulm Ther. 2019;5(2):165–77.

Article  Google Scholar 

Price D, Bosnic-Anticevich S, Briggs A, Chrystyn H, Rand C, Scheuch G, et al. Inhaler competence in asthma: common errors, barriers to use and recommended solutions. Respir Med. 2013 Dec 20;107(1):37–46.

Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies L, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess. 2001;5(26).

O’Connor BJ. The ideal inhaler: design and characteristics to improve outcomes. Respir Med. 2004;98(Suppl A).

Lavorini F, Magnan A, Christophe Dubus J, Voshaar T, Corbetta L, Broeders M, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102(4):593–604.

Article  Google Scholar 

Molimard M. How to achieve good compliance and adherence with inhalation therapy. Curr Med Res Opin. 2005;21(Suppl 4).

Thomas M, Williams AE. Are outcomes the same with all dry powder inhalers? Int J Clin Pract Suppl. 2005;59(149):33–5.

Article  Google Scholar 

Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9.

Article  Google Scholar 

Sanchis J, Gich I, Pedersen S. Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394–406.

Article  Google Scholar 

Ocakli B, Ozmen I, Tunçay EA, Gungor S, Altinoz H, Adiguzel N, et al. A comparative analysis of errors in inhaler technique among COPD versus asthma patients. Int J Chron Obstruct Pulmon Dis. [Internet]. 2018;13:2941–7.

Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. 2013;107(10):1481–90.

Article  Google Scholar 

Cerveri I, Locatelli F, Zoia M, Corsico A, Accordini S, de Marco R, et al. International variations in asthma treatment compliance: the results of the European Community Respiratory Health Survey (ECRHS). Eur Respir J. 1999;14:288–94.

Article  CAS  Google Scholar 

Restrepo RD, Alvarez MT, Wittnebel LD, Sorenson H, Wettstein R, Vines DL, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371–84.

Article  Google Scholar 

George M. Adherence in asthma and copd: new strategies for an old problem. Respir Care. 2018;63(6):818–31.

Article  Google Scholar 

Aydemir Y. Assessment of the factors affecting the failure to use inhaler devices before and after training. Respir Med. 2015;109(4):451–8.

Article  Google Scholar 

Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018;9:353–67.

Article  Google Scholar 

Deshpande P, Sudeepthi Bl, Rajan S, Abdul Nazir C. Patient-reported outcomes: a new era in clinical research. Perspect Clin Res. 2011;2(4):137.

Sandler N, Holländer J, Långström D, Santtila P, Saukkonen A, Torvinen S. Evaluation of inhaler handling-errors, inhaler perception and preference with Spiromax, Easyhaler and Turbuhaler devices among healthy Finnish volunteers: a single site, single visit crossover study (Finhaler). BMJ Open Respir Res. 2016;3(1).

Rönmark P, Jagorstrand B, Safioti G, Menon S, Bjermer L. Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers. Eur Clin Respir J. [Internet]. 2018;5(1).

Price DB, Thomas V, Richard Dekhuijzen PN, Bosnic-Anticevich S, Roche N, Lavorini F, et al. Evaluation of inhaler technique and achievement and maintenance of mastery of budesonide/formoterol Spiromax® compared with budesonide/formoterol Turbuhaler® in adult patients with asthma: the Easy Low Instruction Over Time (ELIOT) study. BMC Pulm Med. 2018;18(1):1–14.

Article  Google Scholar 

Virchow JC, Rodriguez-Roisin R, Papi A, Shah TP, Gopalan G. A randomized, double-blinded, double-dummy efficacy and safety study of budesonide–formoterol Spiromax® compared to budesonide–formoterol Turbuhaler® in adults and adolescents with persistent asthma. BMC Pulm Med. 2016;16(1).

Schreiber J, Sonnenburg T, Luecke E. Inhaler devices in asthma and COPD patients - a prospective cross-sectional study on inhaler preferences and error rates. BMC Pulm Med. 2020;20(1):1–12.

Article  PubMed  PubMed Central  CAS  Google Scholar 

van der Palen J, Cerveri I, Roche N, Singh D, Plaza V, Gonzalez C, et al. DuoResp® Spiromax® adherence, satisfaction and ease of use: findings from a multi-country observational study in patients with asthma and COPD in Europe (SPRINT). J Asthma. 2020;57(10):1110–8.

Piedra Castro R, et al. Inhala ZS: Eficacia, control de la enfermedad y satisfacción con el dispositivo de inhalación en pacientes con asma. In: Semergen. 2019;45(Espec Congr 1):148.

De Simón Gutiérrez R, et al. Inhala ZS: Eficacia, control de la enfermedad y satisfacción con el dispositivo de inhalación en pacientes con enfermedad pulmonar obstructiva. In: Semergen. 2019;5(Espec Congr 1):149.

Voorham J, Roche N, Benhaddi H, Van Der Tol M, Carter V, Van Boven JFM, et al. Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK. BMJ Open. 2018;8(10).

Voorham J, Roche N, Benhaddi H. Correction: Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK. BMJ Open. [Internet]. 2019;9(6):22051–3.

Gillissen A, Gessner C, Hechenbichler K, Herth FJF, Juenemann R, Kanniess F, et al. Patient satisfaction and clinical outcomes with Budesonide plus formoterol spiromax for asthma and chronic obstructive pulmonary disease: a real-world, observational trial. Respiration. 2019;97(4):292–301.

Article  CAS  Google Scholar 

Roche N, Aguilaniu B, Paternotte S, Dallery N. Real-life association between inhaler technique, patient preference and asthma control in patients with uncontrolled asthma switched to budesonide/formoterol DuoResp® Spiromax® combination. J Asthma. 2021;0(0):1–10.