In patients with asthma treated with fixed-dose combination inhaled corticosteroid/long-acting β2-agonist (FDC ICS/LABA), switching from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) was associated with decreased exacerbations and improved disease control. A historical cohort database study on the subject was conducted using medical records from Ajou University Hospital in Suwon, Korea, and the results were published in Respirology.
Investigators sought to evaluate the persistence and effectiveness of switching from a DPI to a pMDI as FDC ICS/LABA therapy. In the study, persistence of the switch was defined as receiving ≥1 pMDI and no DPI following the switch. Effectiveness of the switch was assessed as the proportion of patients without severe asthma exacerbation and the proportion who achieved risk domain asthma control (RDAC), defined as no asthma-related hospitalization, antibiotics without upper respiratory diagnosis, or acute course of oral corticosteroids, and overall asthma control, (OAC), defined as RDAC and ≤200 µg salbutamol/≤500 µg terbutaline average daily dose, which were compared 1 year following and 1 year prior to the switch.
The study included 2 cohorts: a total switch cohort and an effectiveness cohort. The total switch cohort sought to assess the persistence of a switch from the previous DPI to a pMDI prescription. This cohort included a 1-year baseline period and a 6-month outcome period. The purpose of the effectiveness cohort was to assess the effectiveness of switching from a DPI to a pMDI. This cohort included a 1-year baseline period for patient characterization prior to the index date (ie, the date of first pMDI prescription) and a 1-year outcome period for end point measures.
Of the 85 patients who switched from a DPI to a pMDI and persisted for 1 year, a higher proportion of individuals were free from asthma exacerbations following the switch (mean difference in proportion, 0.129; 95% CI, 0.038-0.220). Moreover, switching to a pMDI was also associated with significantly improved RDAC (75.3% vs 57.7%; P =.001) and OAC (57.7% vs 45.9%; P =.021) in the outcome period compared with the baseline period. Of the 117 patients who switched to an FDC ICS/LABA pMDI, 76.1% persisted in the following 6 months.
The investigators concluded that the findings from this study demonstrated that in a real-life specialist asthma setting, switching from an FDC ICS/LABA to a pMDI was associated with a significantly lower proportion of patients who experienced severe asthma exacerbations and was linked to better asthma control compared with the prior year when the patients were on DPI prescriptions. The majority of patients maintained the switch for ≥6 months.
Park H-S, Yoon D, Lee HY, et al. Real-life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred-dose inhalers in patients with asthma treated with ICS/LABA [published online April 30, 2019]. Respirology. doi:10.1111/resp.13559