Background. Physical and cognitive impairment pose special challenges to the use of inhaler devices such as such as pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs), in elderly COPD patients.

Aim. To assess mastering and maintaining the correct inhaler technique when using the Ellipta DPI compared to the capsule-based Handihaler DPI and to a pMDI in device-naïve elderly COPD patients with cognitive impairment.

Methods. According to a randomised, cross-over study, we studied 70 COPD patients (27 females, mean age 78±5 years) with cognitive impairment (mini-mental state examination 18±2). Primary endpoint was the number of inhaler technique errors after the patient has read the package information leaflet and after enhanced training. Inhaler technique was scored from 0 (poor technique) to 8 (correct technique). Secondary endpoint was the time needed to achieve and maintain correct inhaler use.

Results. We found a significantly (P<0.01) lower percentage of errors when using the Ellipta (5%) than the Handihaler (35%) and the pMDI (50%). The mean total score of the inhalation technique was significantly (P<0.05) higher with Ellipta (7.1±0.3) than with the Handihaler (5.1±0.5) and the pMDI (4.0±0.9) The mean instruction time required to achieve error-free device use was shorter (P<0.01) with Ellipta (3.8±1 min) compared to the Handihaler (10.1±1.8 min) and the pMDI (8.0±2 min).

Conclusions. Most elderly COPD patients with cognitive impairment used correctly the Ellipta DPI with less time required for instruction than when using a capsule-based DPI or a pMDI.