Single inhalers that deliver multiple drugs are associated with greater reductions in healthcare use and are more cost-effective than multiple inhalers that deliver the same drugs for the management of chronic obstructive pulmonary disease (COPD) and asthma, according to a literature review study published in the International Journal of Chronic Obstructive Pulmonary Disease.

The systematic review included 38 published observational, retrospective, and randomized controlled trials that compared single combination inhaler devices with multiple inhalers that delivered the same drugs at the same doses in patients with asthma or COPD. End points included in this review were related to clinical, economic, and adherence to therapy.

Evidence from retrospective administrative claims studies in asthma suggested that single inhalers were associated with significantly more prescription fills than multiple inhalers during 6- and 12-month periods. There were no studies that met the inclusion criteria that compared refill rates in patients with COPD.

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In economic analyses of nonrandomized studies of patients with asthma and COPD, single inhalers were associated with greater reductions in emergency room visits and hospitalizations compared with multiple inhalers that delivered the same medications. Studies also indicated that use of single inhalers were associated with reductions in the use of rescue medication during 6 and 12 month periods in patients with asthma.

Direct costs were lower with single inhalers in 2 randomized trials. In an open-label COPD randomized controlled trial, researchers found that fluticasone propionate/salmeterol single-inhaler therapy was associated with more days in hospital and intensive care unit compared with multiple inhalers. Data from nonrandomized and randomized controlled trials generally demonstrated lower drug costs, indirect and direct costs, and total costs with single vs multiple inhalers.

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Limitations of the review were the lack of long-term data as well as the differences in outcome definitions and methodologic designs across analyzed studies.

Despite these limitations, the investigators wrote that the evidence from the nonrandomized studies provided consistent conclusions “in terms of showing benefits for single-inhaler users compared with multiple-inhaler users receiving the same medication.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Zhang S, King D, Rosen VM, Ismaila AS. Impact of single combination inhaler versus multiple inhalers to deliver the same medications for patients with asthma or COPD: a systematic literature review. Int J Chron Obstruct Pulmon Dis. 2020;15:417-438.