Evaluating the impact of changing inhaler color on perception of symptoms and disease burden in patients with asthma: the FEEL study

Objectives: Patient perception of treatment effectiveness is key to optimizing adherence. This is potentially impacted by color, yet no such studies have been conducted in asthma. This study assessed the influence of pink vs. white pressurized metered-dose inhaler (pMDI) actuators on asthma symptoms perception. Methods: In this double-blind, randomized, multicenter, crossover study, adults with moderate-to-severe asthma received extrafine formulation beclomethasone dipropionate/formoterol furoate (BDP/FF) pMDI for a 2-week run-in. During two, 2-week treatment periods they received BDP/FF pMDI, white in one, pink in the other, using an 'authorized deception' approach (patients were told the inhalers contained the same active ingredients, but device characteristics differed). Endpoints included patient-reported asthma symptoms and psychopharmacological aspects (prior to use: did patients expect an improvement; after use: did they think there had been an improvement; both on 100-point visual analog scales [VAS]). Results: Of 74 patients analyzed, 72 completed the study. There were no statistically significant differences between inhalers for asthma symptoms, with minimal changes from baseline. Patients were numerically more likely to expect symptoms improvement with the white than pink inhaler (mean VAS 64.5 vs. 60.8). Perceived improvements were lower than expected with both, numerically favoring the pink inhaler (mean VAS 41.1 vs. 44.6); 46.6% believed a change had been made, 51.9% of whom believed this impacted symptoms. Conclusions: Changing inhaler color had no impact on asthma symptoms, but did have a numerical impact on patients' expectations of subsequent treatment effect. This emphasizes the importance of communication between patients and healthcare practitioners when changing inhalers.