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

Abstract

Inhaled therapies are central to the treatment of asthma and chronic obstructive pulmonary disease. Physicians consider many factors when selecting the most appropriate inhaler device, including device efficacy and the cost to the health care system. This review aims to discuss the factors that are important when considering inhaler devices and the importance of continuity in the choice of inhaler device.A large number of factors can contribute to therapeutic outcomes with inhalation devices. The inhalation technique is critical to treatment success and differs substantially between inhaler devices. Misuse of an inhaler is common, and thorough training of patients and physicians is important to ensure correct utilization. Patient satisfaction is an important consideration because it is significantly correlated with compliance and better outcomes. Financial pressures contribute to decision making: although selecting the less expensive inhaler device might reduce direct treatment costs, it can have a large impact on disease control and the patient's well-being. Switching may be associated with a poor inhalation technique, reduced disease control and quality of life, increased use of other treatments and health care resources, and a greater chance of unsuccessful treatment. Nonconsensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control. It is recommended that patients with stable disease remain on their current device. If a switch is considered, the patient should be consulted and the physician should take into account the patient's preference, their ability to correctly use the device, and the availability of the preferred drug in the preferred device.

Budesonide inhaler device switch patterns in an asthma population in Swedish clinical practice (ASSURE)

“…In concordance with our findings, Thomas and co‐workers have shown that real‐world asthma outcomes vary depending on the device, suggesting that devices are not interchangeable . In a recently published work, it is recommended that patients with stable disease should remain on their current device . This has also been stated in ERS/ISAM taskforce report .…”

Comparison of correct technique and preference for Spiromax®, Easyhaler® and Turbuhaler®: a single-site, single-visit, crossover study in inhaler-naïve adult volunteers

“…Suboptimal adherence and inhaler mishandling have adverse effects on disease control, while satisfaction with inhaler devices is associated with improved adherence, improved clinical outcomes and reduced cost [9–11]. In turn, devices associated with the lowest numbers of handling errors have the highest patient preference ratings [12,13], suggesting that a patient’s acceptance of a device may be correlated with ease of handling.…”

Difference in resistance to humidity between commonly used dry powder inhalers: an in vitro study

“…Suboptimal inhaler technique 7 and inhaler mishandling 8 are still common in real-life use, and lack of device continuity may increase these problems. 9,10 By the availability of many new products, using different devices to deliver drugs to the lungs, asthma and COPD patients are likely to be exposed to more than one type of inhaler during their treatment journey, potentially also concurrently.…”