medwireNews: Results of a real-world study suggest that changing from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) is not associated with compromised treatment outcomes among patients with asthma.
Kwang-Ha Yoo (Konkuk University Hospital, Seoul, South Korea) and colleagues used the Korean Health Insurance and Review Assessment database to analyse data from 1991 patients treated with a fixed-dose combination of inhaled corticosteroids (ICS) and a long-acting beta agonist who switched from the DPI to the pMDI formulation between 2010 and 2015. Patients were aged between 12 and 80 years (average 59 years), and 53% were male.
The researchers found that 57.9% of patients persisted with the inhaler change, defined as receiving at least one prescription for the pMDI in the 6-month period following the switch, with no prescription for the DPI formulation over the same time period. And 56.7% of patients remained on the same pMDI inhaler during the 6-month follow-up.
In an analysis of longer follow-up data from 667 patients, 58.3% remained free from exacerbations in the year after changing from a DPI to a pMDI, compared with 47.4% during the year prior to the change, demonstrating noninferiority of effectiveness.
Moreover, noninferiority of effectiveness was also shown when 642 of these switch patients were matched on variables including age, sex, and average daily dose of ICS to 1926 patients who continued with the DPI formulation, with a comparable 40.6% and 41.0%, respectively, remaining free from exacerbations over 1 year of follow-up.
An exploratory analysis of secondary outcomes showed that patients switching to a pMDI had significantly less severe exacerbations and a significantly higher average daily ICS dose than those remaining on a DPI, the researchers add.
“In summary, for the majority of asthma patients, these results indicate equal effectiveness regarding asthma outcomes following the change from a DPI to a pMDI”, write the study authors in JACI: In Practice.
They stress, however, that “in practice this switch should always be supervised and guided by an experienced physician”, with reasons for switching “properly explained to the patient”. Additionally, “for patients with insufficient breath-hand coordination, pMDIs should always be co-prescribed with a spacer”, they add.
Yoo and team also report that changing to a pMDI was “associated with similar costs as remaining on a DPI”, with total average treatment costs of KRW 2,073,305 (US$ 1823; € 1587) versus KRW 1,927,458 ($ 1694; € 1475).
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