Which inhaled corticosteroid and long-acting β-agonist combination is better in patients with moderate-to-severe asthma, a dry powder inhaler or a pressurized metered-dose inhaler?

Abstract

Two main types of devices are used to facilitate the administration of inhaled corticosteroid (ICS) and long-acting β-agonist (LABA) in combination, dry powder inhalers (DPIs) and pressurized metered-dose inhalers (pMDIs). There are few reports comparing the effects of the two devices, and it is unknown which should be recommended for asthma patients with given sets of characteristics. In the current study, the beneficial effects and side effects associated with DPIs and pMDIs were compared, and the question of which device should be recommended for asthma patients was investigated. A prospective, randomized, crossover, comparative study in adult outpatients with asthma was conducted using salmeterol/fluticasone propionate combination (SFC) 50 μg/250 μg, one inhalation of Adoair 250 Diskus twice daily or two inhalations of Adoair 125 Aerosol twice daily, for 8 weeks. Questionnaires, exhaled nitric oxide (FeNO) tests and pulmonary function tests were administered after the use of each device for 8 weeks, and the results derived from each device were compared. Sixty-eight subjects were included in the final analysis. There were no significant differences between quality-of-life scores, FeNO, spirometry test results and forced oscillation results. With regard to patient preferences, 57.4% preferred the Adoair Aerosol and 35.3% preferred the Adoair Diskus, as determined via the comparative evaluation questionnaire. Although DPI prescription accounts for the predominant market share of combined ICS/LABA in Japan, patients preferred a pMDI device to a DPI device. Compared to DPIs, pMDIs may be the preferential choice for patients with asthma.

Reducing carbon footprint of inhalers: analysis of climate and clinical implications of different scenarios in five European countries

“…Patient outcomes are directly linked to treatment success and restricting access to some treatment options has potentially detrimental effects on the quality of care that patients receive and their subsequent outcomes. 16 17 26 27 Indeed, patient preference, adherence and inhalation technique are important closely inter-related determinants of clinical outcomes. As such, they may also influence healthcare costs.…”

“…15 However, changing inhaler class has important implications for patients, since pMDIs are more suitable for many patients because of, for example, inhaler type, insufficient inspiratory flow rate, or handling capabilities and individual preference. 16 Moreover, switching from pMDIs to DPIs could have other environmental impacts, including human toxicity, marine eutrophication and fossil depletion. 8 Therefore, there is an unmet need to ensure that patients continue to receive the most effective and appropriate treatment while also reducing the negative impact of inhalers on the environment.…”

Minimising the environmental impact of inhaled therapies: problems with policy on low carbon inhalers

“…Patient preference is important in achieving effective treatment and many patients prefer pMDIs. In a non-industry funded study comparing the same drug given to patients with asthma as either a pMDI or as a DPI, nearly double the number of patients (∼60%) preferred the pMDI device compared to the DPI (∼35%) [10]. Evidence on the error rates that patients have using the different inhaler devices in routine daily use is conflicting, with no convincing evidence for the superiority of any one device type over another.…”

<p>The Climate is Changing for Metered-Dose Inhalers and Action is Needed</p>

“…For example, despite the high DPI usage, a recent study reported that Japanese patients may still prefer a pMDI to a DPI. 27 Furthermore, there are clearly local factors which can influence prescriber choice, given that the proportion of inhaler doses (excluding nebulized) given by pMDI ranges from 34% in Japan to 88% in the US ( Figure 5 ). Differing health policies, costs, health insurance issues, commercial aspects and prescribers’ and patients’ preferences can cause significant variation in prescribing practice, even within the European Union.…”