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

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


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

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / economics
  • Adrenergic beta-2 Receptor Agonists / administration & dosage*
  • Adrenergic beta-2 Receptor Agonists / economics
  • Adult
  • Aged
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / economics
  • Asthma / drug therapy*
  • Asthma / economics
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / economics
  • Cost of Illness
  • Dry Powder Inhalers* / economics
  • Female
  • Humans
  • Male
  • Metered Dose Inhalers* / economics
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Adrenergic beta-2 Receptor Agonists
  • Anti-Asthmatic Agents
  • Bronchodilator Agents