Asthma and COPD: Interchangeable use of inhalers. A document of Italian Society of Allergy, Asthma and Clinical Immmunology (SIAAIC) & Italian Society of Respiratory Medicine (SIMeR)

Abstract

Prescription cost-containment measures are increasing in many European countries and, as more inhaler devices become available, there may be pressure to switch patients from reference inhaled medication to cheaper generic inhaled drugs. Indeed, in some countries, such a substitution is mandated by current regulations, and patients who do not accept the substitution have to pay the difference in cost. Generic inhaled drugs are therapeutically equivalent to original branded options but may differ in their formulation and inhalation device. This new situation raises questions about the potential impact of switching from branded to generic inhaled medications in patients with asthma or chronic obstructive pulmonary disease (COPD), with or without their consent, in countries where this is permitted. Acquisition cost savings from a substitution could be offset by costs related to deterioration in asthma control or worsening in COPD outcomes if the patient is unable or unwilling to use the inhaler device properly. Non-adherence to therapy and incorrect inhaler usage are recognised as major factors in uncontrolled asthma and worsening of COPD outcomes. Switching patients to a different inhaler device may exacerbate these problems, particularly in patients who disagree to switch. Where switching is permitted or mandatory, it is crucial that the reason for switching has been properly explained to the patient and adequate instruction for operating correctly the inhaler have clearly been provided.

Switching treatments in COPD: implications for costs and treatment adherence

“…When a generic inhaler replaces a branded inhaler, patients should be willing to use the new inhaler and receive adequate training. 35 Importantly, the responsibility for such training needs to be clarified, because physicians may not be aware that a prescribed branded inhaler has been replaced with a generic one at the pharmacy. 36 …”

Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD

“…Each type of inhaler device has pros, as well as, cons [148] and differs in its efficiency of Proceedings appropriately than those using a single device type [169,170], and device switching without a face-to-face review is associated with worsening of asthma control [170,171].…”

Inhalation errors due to device switch in patients with chronic obstructive pulmonary disease and asthma: critical health and economic issues

“…Inappropriate inhaler use and a low adherence to inhaled treatments could lead to poorer asthma and COPD control, and switching devices without suitable training could worsen these problems. 11 …”