Location of Repository

Inhaled corticosteroids for asthma: impact of practice level device switching on asthma control

By Mike Thomas, David Price, Henry Chrystyn, Andrew Lloyd, Angela E. Williams and Julie von Ziegenweidt

Abstract

Background\ud As more inhaled corticosteroid (ICS) devices become available, there may be pressure for health-care providers to switch patients with asthma to cheaper inhaler devices. Our objective was to evaluate impact on asthma control of inhaler device switching without an accompanying consultation in general practice.\ud \ud \ud Methods\ud This 2-year retrospective matched cohort study used the UK General Practice Research Database to identify practices where ICS devices were changed without a consultation for ≥5 patients within 3 months. Patients 6–65 years of age from these practices whose ICS device was switched were individually matched with patients using the same ICS device who were not switched. Asthma control over 12 months after the switch was assessed using a composite measure including short-acting β-agonist and oral corticosteroid use, hospitalizations, and subsequent changes to therapy.\ud \ud \ud Results\ud A total of 824 patients from 55 practices had a device switch and could be matched. Over half (53%) of device switches were from dry powder to metered-dose inhalers. Fewer patients in switched than matched cohort experienced successful treatment based on the composite measure (20% vs. 34%) and more experienced unsuccessful treatment (51% vs. 38%). After adjusting for possible baseline confounding factors, the odds ratio for treatment success in the switched cohort compared with controls was 0.29 (95% confidence interval [CI], 0.19 to 0.44; p < 0.001) and for unsuccessful treatment was 1.92 (95% CI, 1.47 to 2.56; p < 0.001).\ud \ud \ud Conclusion\ud Switching ICS devices without a consultation was associated with worsened asthma control and is therefore inadvisable

Topics: RS
Publisher: Biomed Central
Year: 2009
OAI identifier: oai:eprints.hud.ac.uk:6362

Suggested articles

Preview

Citations

  1. (2006). Aerosol Drug Management Improvement Team: The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team. Respir Med doi
  2. (2004). AT: Clinical and economic effects of suboptimally controlled asthma. Manag Care Interface
  3. (2004). CC: Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. doi
  4. (2007). Chrystyn H: Survey of pharmacists' attitudes towards interchangeable use of dry powder inhalers. Pharm World Sci doi
  5. (2005). Comparing clinical features of the nebulizer, metered-dose inhaler, and dry powder inhaler. Respir Care
  6. (2001). Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess doi
  7. Could interchangeable use of dry powder inhalers affect patients? doi
  8. (2003). Database studies in asthma pharmacoeconomics: uses, limitations and quality markers. Expert Opin Pharmacother doi
  9. (2005). Daures JP: The public health implications of asthma. Bull World Health Organ
  10. Do healthcare professionals think that dry powder inhalers can be used interchangeably? doi
  11. Do patients think that dry powder inhalers can be used interchangeably? doi
  12. (2006). Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) doi
  13. (1996). Klim JB: The costs of asthma. doi
  14. (2005). Methods of delivering drugs. doi
  15. (2003). morbidity, and control of asthma in Hungary: The Hunair Study. doi
  16. Outcome measures in asthma. Thorax 2000, 55(Suppl 1):S70-74. Pre-publication history The pre-publication history for this paper can be accessed here:
  17. (2008). PJ: Importance of inhaler devices in the management of airway disease. Respiratory Medicine doi
  18. (2000). RH: Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest doi
  19. (2000). Risk factors and costs associated with an asthma attack. Thorax doi
  20. Scottish Intercollegiate Guidelines Network: British Guideline on the Management of Asthma. doi
  21. (2005). Short-acting beta-agonist prescription fills as a marker for asthma morbidity. Chest doi
  22. The General Practice Research Database doi
  23. (1999). Use of the General Practice Research Database (GPRD) for respiratory epidemiology: a comparison with the 4th Morbidity Survey in General Practice (MSGP4). Thorax doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.