Potential negative consequences of non‐consented switch of inhaled medications and devices in asthma patients

Abstract

BackgroundAsthma requires individually tailored and careful management to control and prevent symptoms and exacerbations. Selection of the most appropriate treatment is dependent on both the choice of drugs and inhaler device; however, financial pressures may result in patients being switched to alternative medications and devices in an attempt to reduce costs.AimThis review aimed to examine the published literature in order to ascertain whether switching a patient’s asthma medications or device negatively impacts clinical and economic outcomes.Materials and methodsA literature search of MEDLINE (2001–13 September 2011) was conducted to identify English-language articles focused on the direct impact of switching medications and inhaler devices and switching from fixed-dose combination to monocomponent therapy via separate inhalers in patients with asthma; the indirect impacts of switching were also assessed.ResultsEvidence showed that non-consented switching of medications and inhalers in patients with asthma can be associated with a range of negative outcomes, at both individual and organisational levels. Factors that reduce adherence may lead to compromised symptom control resulting in increased healthcare resource utilisation and poorer patient quality of life.DiscussionThe consequences of a non-consented switch should be weighed carefully against arguments supporting an inhaler switch without the patient’s consent for non-medical/budgetary reasons, such as potential reductions in initial acquisition costs, which may be associated with subsequent additional healthcare needs.ConclusionGiven the increasing pressure for reduced costs and efficient allocation of limited healthcare resources, an additional investment in ensuring high medication adherence may lead to greater savings due to a potentially decreased demand for healthcare services. In contrast, savings achieved in acquisition costs may result in a greater net loss due to increased healthcare consumption caused by decreased asthma control.

The Importance of Continuity in Inhaler Device Choice for Asthma and Chronic Obstructive Pulmonary Disease

“…4 Implications for switching inhaler devices from the perspective of the patient and the health care system [31]. …”

“…Compared to savings from direct costs alone, investing in training and education to ensure that there is a high level of adherence to the treatment may lead to greater savings through reduced demands on health care systems and consultations [31]. Furthermore, when switching to another treatment the implications for disease control must be considered because the cost of emergency treatment is acknowledged as being greater than that of planned treatment [3].…”

Impact of changes to reimbursement of fixed combinations of inhaled corticosteroids and long‐acting β 2 ‐agonists in obstructive lung diseases: a population‐based, observational study

“…Use of ICS and LABA monocomponents is associated with a higher risk of exacerbations and higher reliever use than fixed ICS/LABA combinations via a single inhaler . Non‐consensual inhaler switches in patients with controlled asthma have been linked with reduced disease control . Finally, using LABA monotherapy without a concurrent ICS leads to poorer outcomes in asthma and is associated with increased mortality; therefore, the use of separate inhalers should be avoided to prevent use of LABA monotherapy .…”

“…Non-consensual inhaler switches in patients with controlled asthma have been linked with reduced disease control (5)(6)(7). Finally, using LABA monotherapy without a concurrent ICS leads to poorer outcomes in asthma and is associated with increased mortality; therefore, the use of separate inhalers should be avoided to prevent use of LABA monotherapy (8,9).…”

Optimizing the language and format of guidelines to improve guideline uptake

“…Patients may be reluctant to change their inhaler device because of personal preference and concerns about adverse effects. 41,42 The guideline developers themselves acknowledged that a switch to budesonideformoterol has been associated with a twofold increase in discontinuation due to adverse effects. 33,43 Pressure on physicians to accommodate patient preference plays an important role in guideline adherence.…”