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

Chin Kook Rhee, Job F M van Boven, Simon Wan Yau Ming, Hye Yun Park, Deog Kyeom Kim, Hae-Sim Park, Joanna Ling Zhi Jie, Kwang-Ha Yoo (Corresponding Author), David B Price

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)934-942
Number of pages9
JournalThe journal of allergy and clinical immunology. In practice
Issue number3
Early online date5 Oct 2018
Publication statusPublished - 31 Mar 2019

Bibliographical note

This study was funded by Mundipharma Korea Limited (Seoul, Korea).


  • asthma
  • inhaler
  • dry powder inhaler
  • pressurized metered-dose inhaler
  • cost-effectiveness
  • Dry powder inhaler
  • Economic evaluation
  • Inhaler
  • Pressurized metered-dose inhaler
  • Cost-effectiveness
  • Asthma
  • CARE


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