The negative impact of inhaler switching
Reduced adherence
Treatment adherence is the extent to which a patient follows a prescribed medical treatment plan and is essential for optimal respiratory disease control. However, adherence is commonly reduced (both intentionally and unintentionally) upon inhaler switching.[15] It is important, therefore, that clinicians consider patient needs, preferences and inhaler satisfaction when choosing the most appropriate treatment choice, as these factors greatly affect whether patients take their medication or not.[17, 18]
Worse disease control
There is a direct relationship between reduced inhaled medication adherence and reduced respiratory disease control.[19] For example, those who do not take their medication as instructed are more likely to have more frequent exacerbations (i.e. attacks).[20]
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The consequences of poor adherence to medications (e.g. hospital admissions) is never environmentally friendly, so a switch from a pressurized metered dose inhaler (pMDI) (reliever and preventer) with good adherence to a different device with worse adherence is neither good for the environment nor the patient.[18, 21]
Increased use of healthcare resources and increased costs
Reduced disease control caused by inhaler switching, can increase healthcare resource consumption (e.g. more doctor visits) and costs.[15, 18]
Increased time cost
Switching inhaler devices requires time and resources in order to instruct patients on the correct technique;[22] Up to 35 minutes/patient is required to adequately implement an inhaler switch.[23]
Inhaler use errors
Although there are a large number of dry powder inhalers (DPIs) available for patients to switch to, these devices differ greatly in their design and features. Therefore, an inhaler switch requires additional training and patients cannot, or do not, use all DPIs equally well.[24] DPIs also require forceful inhalation to deliver the medicine properly, and not all patient subgroups are capable of actuating the device correctly.[12, 25] Drug delivery is dependent on many factors including device characteristics, medication, drug particle size, shape and density, lung deposition and ease of use.[16, 25] Inability to use an inhaler correctly can be life threatening.[26]
Harm to the doctor-patient relationship
Switching inhalers can harm the doctor-patient relationship, especially when done in the absence of collaboration with the patient.[27]
