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1 Supplementary materials Table S1 Patient comorbidities by diagnosis Total Asthma n (%) 5348 (148.4) COPD n (%) 4563 (143.4) ACOS n (%) 469 (197.9) No other comorbidities 95 (26.4) 614 (19.3) 27 (11.4) Alpha-1 antitrypsin deficiency 1 (.) 4 (.1) 1 (.4) AIDS/HIV 5 (.1) 5 (.2) () Allergic dermatitis 224 (6.2) 15 (.5) 7 (3.) Allergic rhinitis 1619 (44.9) 66 (2.1) 3 (12.7) Anemia 36 (1.) 75 (2.4) 7 (3.) Anxiety 48 (11.3) 391 (12.3) 42 (17.7) Arthritis 132 (3.7) 372 (11.7) 33 (13.9) Atopic dermatitis 5 (1.4) 9 (.3) 6 (2.5) Cancer 34 (.9) 82 (2.6) 6 (2.5) Crohn s disease 14 (.4) 21 (.7) 2 (.8) Connective tissue/rheumatological disease 17 (.5) 1 (.3) () Cystic fibrosis 2 (.1) () () Dementia 5 (.1) 36 (1.1) 2 (.8) Depression 296 (8.2) 376 (11.8) 57 (24.1) Dermatitis/eczema 48 (1.3) 23 (.7) 4 (1.7) Diabetes 192 (5.3) 531 (16.7) 48 (2.3) Dyspepsia/stomach pain 91 (2.5) 118 (3.7) 17 (7.2) Gastroesophageal reflux disease 378 (1.5) 397 (12.5) 47 (19.8) Glaucoma 25 (.7) 82 (2.6) 6 (2.5) Hyperthyroidism 4 (1.1) 45 (1.4) 5 (2.1) Idiopathic pulmonary fibrosis 1 (.) 2 (.1) 3 (1.3) Liver disease 16 (.4) 49 (1.5) 2 (.8) Lung cancer 4 (.1) 54 (1.7) 6 (2.5) Obesity 32 (8.9) 289 (9.1) 27 (11.4) Osteoporosis 91 (2.5) 225 (7.1) 32 (13.5) Prostate disorder 61 (1.7) 287 (9.) 18 (7.6) Psoriasis 26 (.7) 19 (.6) 4 (1.7)
2 Total Asthma COPD ACOS n (%) n (%) n (%) 5348 (148.4) 4563 (143.4) 469 (197.9) Peptic ulcer disease 14 (.4) 59 (1.9) 3 (1.3) Renal failure 19 (.5) 83 (2.6) 4 (1.7) Sinusitis 122 (3.4) 42 (1.3) 7 (3.) Sleep apnea 17 (3.) 18 (5.7) 16 (6.8) Systematic sclerosis () 2 (.1) () Cardiovascular conditions Total Asthma COPD ACOS n (%) n (%) n (%) 4135 (113.9) 5226 (162.5) 384 (161.3) No cardiovascular comorbidities 27 (74.3) 941 (29.3) 67 (28.2) Angina pectoris 29 (.8) 187 (5.8) 12 (5.) Cardiac arrhythmias 64 (1.8) 294 (9.1) 17 (7.1) Coagulated blood clotting disorder 2 (.1) 24 (.8) 3 (1.3) Congestive heart failure 34 (.9) 193 (6) 13 (5.5) Coronary artery disease 51 (1.4) 233 (7.2) 17 (7.1) Elevated cholesterol/hyperlipidemia 366 (1.1) 895 (27.8) 73 (3.7) Hypertension 782 (21.5) 19 (59.1) 138 (58.) Myocardial infarction 35 (1.) 175 (5.4) 15 (6.3) Peripheral vascular disease 23 (.6) 195 (6.1) 12 (5.) Pulmonary arterial hypertension 2 (.6) 7 (2.2) 5 (2.1) Cerebrovascular disease and/or stroke 15 (.4) 83 (2.6) 1 (4.2) Thrombosis 14 (.4) 36 (1.1) 2 (.8) Abbreviation: ACOS, asthma COPD overlap syndrome.
3 Table S2 Full list of maintenance treatments prescribed to patients (listed by country) France MDI bamdi DPI SMI Unknown Total Beclomethasone Beclomethasone + formoterol FDC Budesonide Ciclesonide 6 6 Fluticasone Fluticasone + salmeterol FDC Formoterol Formoterol + budesonide FDC Indacaterol Mometasone 6 6 Salmeterol Tiotropium Total Germany MDI bamdi DPI SMI Unknown Total Aclidinium Beclomethasone Beclomethasone + formoterol FDC Budesonide Ciclesonide 4 4 Fluticasone Fluticasone + formoterol FDC 9 9 Fluticasone + salmeterol FDC Fluticasone furoate + vilnaterol FDC 1 1 Formoterol Formoterol + budesonide FDC Glycopyrronium Glycopyrronium + indacaterol FDC Indacaterol Salmeterol Tiotropium Total
4 Italy MDI bamdi DPI SMI Unknown Total Aclidinium Beclomethasone Beclomethasone + formoterol FDC Budesonide Ciclesonide Flunisolide 5 5 Fluticasone Fluticasone + formoterol FDC Fluticasone + salmeterol FDC Formoterol Formoterol + budesonide FDC Glycopyrronium Indacaterol Mometasone Salmeterol Tiotropium Total Spain MDI bamdi DPI SMI Unknown Total Aclidinium Beclomethasone Beclomethasone + formoterol FDC Budesonide Ciclesonide Fluticasone Fluticasone + salmeterol FDC Formoterol Formoterol + budesonide FDC Glycopyrronium 5 5 Indacaterol Mometasone Salmeterol Tiotropium Total
5 UK MDI bamdi DPI SMI Unknown Total Aclidinium 7 7 Beclomethasone Beclomethasone + formoterol FDC Budesonide Ciclesonide 3 3 Fluticasone Fluticasone + formoterol FDC 3 3 Fluticasone + salmeterol FDC Formoterol Formoterol + budesonide FDC Glycopyrronium Indacaterol 8 8 Salmeterol Tiotropium Total Aclidinium Beclomethasone Budesonide Ciclesonide 7 7 Fluticasone Fluticasone + salmeterol FDC Fluticasone furoate + vilanterol FDC 2 2 Formoterol Formoterol + budesonide FDC Indacaterol Mometasone Mometasone + formoterol FDC Salmeterol Tiotropium Triamcinolone Total
6 Japan MDI bamdi DPI SMI Unknown Total Beclomethasone Budesonide Ciclesonide Fluticasone Fluticasone + salmeterol FDC Formoterol 1 1 Formoterol + budesonide FDC Glycopyrronium 3 3 Indacaterol Mometasone 9 9 Olodaterol 1 1 Salmeterol Tiotropium Total China MDI bamdi DPI SMI Unknown Total Bambuterol 1 1 Beclomethasone Budesonide Dexamethasone Fluticasone Fluticasone + salmeterol FDC Formoterol Formoterol + budesonide FDC ICS/LABA (nfs) Indacaterol 1 1 LAMA (nfs) 1 1 Mometasone 2 2 Other (not stated) 2 2 Salmeterol Tiotropium Tulobuterol Total
7 Global MDI bamdi DPI SMI Unknown Total Aclidinium Bambuterol 1 1 Beclomethasone Beclomethasone + formoterol FDC Budesonide Ciclesonide Dexamethasone Flunisolide 5 5 Fluticasone Fluticasone + formoterol FDC Fluticasone + salmeterol FDC Fluticasone furoate + vilanterol FDC 3 3 Formoterol Formoterol + budesonide FDC Glycopyrronium Glycopyrronium + indacaterol FDC ICS/LABA (nfs) Indacaterol LAMA (nfs) 1 1 Mometasone Mometasone + formoterol FDC Olodaterol 1 1 Other (not stated) 2 2 Salmeterol Tiotropium Triamcinolone 2 2 Tulobuterol 1 1 Total Abbreviations: bamdi, breath actuated metered dose inhaler; DPI, dry powder inhaler; FDC, fixed dose combination; ICS, inhaled corticosteroid; LABA, long-acting β2 -agonist; LAMA, long-acting muscarinic antagonist; MDI, metered dose inhaler; nfs, not further specified; SMI, soft mist inhaler.
8 Table S3 Full list of inhaler attributes ranked for importance by patients (5-point Likert scale) Asthma % (n) COPD % (n) ACOS % (n) It is built to last and will not break easily 27.5 (47) 34.7 (224) 29. (11) The instructions are simple and easy to follow 54.6 (88) 6.9 (393) 52.6 (2) No need for me to put the medicine into the inhaler before I use it I do not need to breathe in at the same time as I press my inhaler I do not need to breathe in hard to inhale my medicine I get the same amount of medicine delivered to my lungs each time It tells me when my dose of medicine has been inhaled correctly It tells me how many doses of my medicine I have left 31.4 (465) 25.3 (163) 15.8 (6) 17.2 (254) 19.4 (125) 18.4 (7) 17.4 (257) 2 (129) 23.7 (9) 28.2 (417) 29.3 (189) 18.4 (7) 12.8 (189) 12.1 (78) 15.8 (6) 24.1 (357) 15.5 (1) 21.1 (8) Can reuse the inhaler for more than 1 month 7.8 (115) 1.2 (66) 7.9 (3) The inhaler locks when it is empty so I cannot use it any more 4.6 (68) 3.6 (23) 7.9 (3) Low/no irritation in mouth and throat 19.5 (288) 19.2 (124) 7.9 (3) Easy to hold and carry around with me 33.3 (493) 29.2 (188) 23.7 (9) Total (4118) (182) (92) Abbreviation: ACOS, asthma COPD overlap syndrome.
9 Table S4 Number of patient comorbidities by whether inhaler device is a reason for choice Asthma Ease of use/suitability of inhaler device is: NOT a reason for choice A reason for choice n=1869 n=978 P-value between groups No other comorbidities, % (n) 31.1 (581) 21.2 (213) <.1 Total number of comorbidities, mean (95% CI) COPD n=1932 n= (2 2.6) 2.5 ( ) <.1 n=1815 n=947 No other comorbidities, % (n) 21.9 (39) 17.2 (151).48 Total number of comorbidities, mean (95% CI) ACOS n=1851 n= ( ) 4.5 ( ) <.1 n=121 n=61 No other comorbidities, % (n) 14.3 (17) 12.1 (7).8167 Total number of comorbidities, mean (95% CI) n=121 n= (4. 5.5) 5.4 ( ).2423 Abbreviations: ACOS, asthma COPD overlap syndrome; CI, confidence interval.
10 Table S5 Current device type by whether inhaler device is a reason for choice Ease of use/suitability of inhaler device is: NOT a reason for choice A reason for choice Asthma, % (n) n=1939 n=114 P-value between groups MDI 34.7 (673) 34.2 (347).869 bamdi 1.1 (21) 1.5 (15).3788 DPI 62.9 (122) 66. (669).164 SMI.3 (6).6 (6).361 Unknown device 4.3 (84) 3.3 (33).1651 COPD, % (n) n=1861 n=911 MDI 18.9 (351) 16.5 (15).1278 bamdi.8 (15) 1.1 (1).5214 DPI 87.6 (1631) 9. (82).672 SMI 3.9 (73) 5.9 (54).22 Unknown device 4.6 (86) 2.7 (25).176 ACOS, % (n) n=121 n=61 MDI 29.8 (36) 18. (11).171 bamdi 1.7 (2) ().5519 DPI 82.6 (1) 86.9 (53).5256 SMI 2.5 (3) 1.6 (1) 1 Unknown device 5.8 (7) 11.5 (7).2375 Abbreviations: ACOS, asthma COPD overlap syndrome; bamdi, breath actuated metered dose inhaler; DPI, dry powder inhaler; MDI, metered dose inhaler; SMI, soft mist inhaler.
11 Figure S1 Inhaler satisfaction as reported by patients by diagnosis (not at all/slightly satisfied) Abbreviation: ACOS, asthma COPD overlap syndrome.
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