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J Allergy Clin Immunol Pract. 2019 Mar;7(3):934-942. doi: 10.1016/j.jaip.2018.09.027. Epub 2018 Oct 5.

Does Changing Inhaler Device Impact Real-Life Asthma Outcomes? Clinical and Economic Evaluation.

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Division of Pulmonary, Allergy and Critical Care Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
Observational and Pragmatic Research Institute, Singapore.
Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyun Kwan University School of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Seoul National University, SMG-SNU Boramae Medical Center, Seoul, Korea.
Allergy and Clinical Immunology Department, Ajou University Medical Center, Seoul, Korea.
Division of Pulmonary and Allergy, Department of Internal Medicine, School of Medicine, Konkuk University, Seoul, Korea. Electronic address:
Observational and Pragmatic Research Institute, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.



Inhaler usability and deposition differ between devices. Change of device may therefore have an impact on clinical and economic outcomes.


To characterize clinical and economic asthma outcomes surrounding the change from a dry powder inhaler (DPI) to a pressurized metered-dose inhaler (pMDI) for fixed-dose combination inhaled corticosteroid/long-acting β agonist (FDC ICS/LABA) treatment.


Three retrospective cohort substudies using 2010 to 2015 data from the Korean Health Insurance and Review Assessment Service database were performed. Patients with asthma who received an FDC ICS/LABA pMDI for the first time after initially being on FDC ICS/LABA DPI were included. The following outcomes were assessed: (1) persistence of change to pMDI over 6 months, (2) clinical outcomes during the year after the change compared with the baseline year; and (3) noninferiority comparison of costs and effectiveness between patients changing to a pMDI and matched patients who continued their DPI.


Patients who change inhalers seem to represent a more severe subpopulation. Fifty-eight percent of patients (95% CI, 56-60) persisted with the change. After the change in therapy, an increased proportion of patients (58.3%) remained free from severe exacerbations compared with the year before (47.4%; P < .001). Patients who changed to pMDIs had significantly less severe exacerbations, acute respiratory events, and lower short-acting β agonist inhaler average daily dose, but higher average ICS daily dose (all P < .05), compared with matched patients remaining on a DPI. Total costs were similar between patients who changed to pMDI therapy compared with those remaining on a DPI.


Changing from a DPI to a pMDI for FDC ICS/LABA asthma treatment can be as effective and cost-effective as remaining on a DPI.


Asthma; Cost-effectiveness; Dry powder inhaler; Economic evaluation; Inhaler; Pressurized metered-dose inhaler


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