Effectiveness of Same Versus Mixed Asthma Inhaler Devices: A Retrospective Observational Study in Primary Care

Abstract

PurposeCorrect use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy.MethodsThis retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma).ResultsPatients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452).ConclusionsThese findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.

Real-world asthma management with inhaler devices in Switzerland—results of the asthma survey

“…The fact that rescue asthma medication (SABA) is generally formulated as a pMDI may have been perceived as a contribution to the ease of use of pMDI in general, capitalizing on already trained and hopefully mastered skills. This is consistent with the recommendation not to switch between different inhalers, as each inhaler class and brand has its own unique requirements regarding handling and inhalation technique (29)(30)(31). In addition, patients do express preference for particular inhaler devices, which makes successful teaching easier (32,33).…”

Evaluation of In Vitro and In Vivo Flow Rate Dependency of Budesonide/Formoterol Easyhaler®

“…It should be a clear advantage if all drugs to be inhaled could be administered via the same inhaler with easy and identical instructions for use. (32) To provide asthma and COPD patients with a reliable inhaler platform with which several active substances can be administered, a new product with EH dmDPI was developed. One of the main targets of the development work with the budesonide/formoterol combination was to demonstrate comparable in vitro flow rate dependency to the reference budesonide/formoterol product, Symbicort TH.…”

Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD

“…Both time constraints and inadequate knowledge amongst health care professionals (HCPs) can lead to ineffective patient education. In a review of 20 relevant studies, only 28% of doctors and 22% of nurses were able to describe, or perform, all the critical steps for using inhalers [167].…”