Do patients think that dry powder inhalers can be used interchangeably?

Abstract

As recognised in management guidelines, patients are the most important group of people in any prescribing decision. Despite their importance, few studies have asked what patients think about being switched between different inhalers. This paper reports two such studies, one involving interviews of a sample of patients and the other consisting of a quantitative survey of patients across five countries. In the qualitative study, four of the five patients interviewed reported that they would be confused, worried and unhappy about a switch in their dry powder inhaler and would revisit their physician to be shown how to use the inhaler or to ask for a new prescription for their old inhaler. In the quantitative survey of 499 patients with asthma, more than half (51%) were opposed to their current dry powder inhaler being replaced by a substitute device, with 83% reporting concerns. There was considerable concern about training in use of the new device and confusion about the need for change. Almost a quarter of patients (23%) would want training, and 23% of patients thought they would need information about the new inhaler. From limited information, it appears that patients would be concerned about switching of their existing dry powder inhaler for another, with the potential for confusion, need for additional consultations and need for training in the new device.

Switching from branded to generic inhaled medications: potential impact on asthma and COPD

“…Increasing the risk of poor adherence by switching inhalers without consultation is likely to add to these problems. Both healthcare professionals [30,32] and patients [31] are generally negative toward switching of DPIs without adequate consultation.…”

“…Correct inhalation technique is necessary for attaining the full benefit of inhaled medications [18] but inhalers are often used incorrectly unless patients receive adequate instruction [19,28]. Patient education and involvement in treatment decisions can improve adherence to therapy [29] but adherence is likely to decline in patients who have treatment switched without consultation [30,31]. Non-compliance rates already range from 16 to 50% among patients with asthma and COPD, and this contributes to the morbidity, mortality and associated costs of these conditions [6,7].…”

Obstructive lung diseases and inhaler treatment: results from a national public pragmatic survey

“…Although they prefer to maintain the same device when a change in dose or drug is necessary, device users must be informed about how a new device works, and they prefer to be informed by their physician. The need for a real partnership is underlined by most patients as a fundamental step during the switching of any device [31,32]. …”

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)

“…Indeed, patient preference for different DPIs varies [17], indicating that they are not all the same from the patient's perspective, although patient preference for a device does not ensure either improved compliance or adherence. Thus, inhaler devices should be prescribed with no switching of device without the involvement of both physician and patient [35]. Should substitution of a generic for a branded inhaler be permitted, safeguards are required to ensure that patients receive adequate training and are willing to use the new device.…”