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Does changing inhaler device change asthma outcomes?

Published online: October 5, 2018

Most people with asthma rely on inhaled asthma medication to control their symptoms. Inhaler devices are available as either dry powder inhaler (DPI) or pressurized metered dose inhaler (pMDI). Both devices require different inhaler handling and inhalation techniques, therefore, matching the device type to deliver asthma reliever and controller treatment may be preferred. Yet, the majority of people with asthma use a pMDI as their reliever, but often a DPI is used as a controller. On the one hand, this “mismatch” may offer an opportunity to improve asthma management. On the other hand, a change of devices (without proper patient guidance) may also lead to worse outcomes due to confusion.

A recent study published in The Journal of Allergy and Clinical Immunology: In Practice conducted by Rhee and colleagues investigated the clinical and economic consequences of changing patients’ DPI device to deliver asthma controller to a pMDI. The authors utilized data from South Korea’s Health Insurance Review and Assessment Service (HIRA) database that contains healthcare utilization data from the entire South Korean population. The researchers investigated whether patients who changed from a DPI to a pMDI experienced better treatment outcomes compared to patients who remained on a DPI. The researchers also compared the healthcare utilization cost (such as asthma-related medication and hospitalization) between both patient groups.

The authors analyzed 642 patients who changed from a DPI to a pMDI and matched these to 1926 patients who remained on a DPI. Within a one-year period, patients who changed experienced significantly less severe asthma attacks and acute respiratory events (including asthma-related hospitalization), albeit using a higher controller therapy dosage. Overall healthcare utilization was comparable between patients who changed to a pMDI and those who remained on a DPI.

In conclusion, this study showed that changing inhaler controller devices led to at least comparable clinical effectiveness as well as healthcare costs. Regardless, the authors highlighted that practitioners should always consider patients’ individual needs and stress that proper patient guidance during a change of inhaler device is essential.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

18-00338 Does changing inhaler device impact real-life asthma outcomes? Clinical and economic evaluation