Real-life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred-dose inhalers in patients with asthma treated with ICS/LABA

Hae-Sim Park, Dukyong Yoon, Hyun Young Lee, Ga-Young Ban, Simon Wan Yau Ming, Joanna Ling Zhi Jie, Victoria Carter, Antony Hardjojo, Job F.M. Van Boven, David B. Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


Background and objective
Mixed inhaler device use for asthma is associated with worse inhaler technique and outcomes. Given that relievers are commonly prescribed as pressurized metred‐dose inhalers (pMDI), changing preventers from dry powder inhalers (DPI) to pMDI may improve asthma outcomes. This study aimed to assess the persistence and effectiveness of switching from DPI to pMDI for inhaled corticosteroid and long‐acting β2‐agonist combination therapy (ICS/LABA).

This was a historical cohort study using Ajou University Hospital (Korea) patient records. Persistence of switch was defined as receiving ≥1 pMDI and no DPI after the switch. Effectiveness of switch was assessed as the proportion without severe asthma exacerbation and the proportion achieving risk domain asthma control (RDAC; no asthma‐related hospitalization, antibiotics without upper respiratory diagnosis or acute course of oral corticosteroids) and overall asthma control (OAC; RDAC and ≤ 200 μg salbutamol/≤500 μg terbutaline average daily dose) comparing 1 year after and before the switch.

Within 85 patients who switched from DPI to pMDI and persisted for a year, higher proportion were free from asthma exacerbation after the switch (mean difference in proportion = 0.129, 95% CI: 0.038–0.220). Switching to pMDI was also associated with better RDAC (75.3% vs 57.7%, P = 0.001) and OAC (57.7% vs 45.9%, P = 0.021). From the entire 117 patients who switched to fixed‐dose combination (FDC)/ICS LABA pMDI, 76.1% (95% CI: 69.0–100.0%) patients persisted in the following 6 months.

Switching to and persisting with pMDI was associated with decreased asthma exacerbations and improved asthma control. The majority of patients persisted with the switch to pMDI for ICS/LABA treatment.
Original languageEnglish
Pages (from-to)972-979
Number of pages8
Issue number10
Early online date30 Apr 2019
Publication statusPublished - Oct 2019

Bibliographical note

Data availability statement:: The data set supporting the conclusions of this article was derived from the Electronic Medical Record Database of Ajou University Hospital (Allergy and Clinical Immunology Department). The authors received ethics approval for purely observational research by the IRB of Ajou University Hospital. The authors do not have permission to give public access to the study data set. Data can be requested from the Ajou University Hospital IRB and access is subject to their approval.

This study was funded by Mundipharma Pte Ltd and was co‐supported by a grant of the Korean Health Technology R&D Project through the KHIDI, funded by the Ministry of Health & Welfare, ROK(HI16C0992). BDP/FORM (Foster) is a trademark of Chiesi Farmaceutici. FP/FORM (Flutiform) is a trademark of Jagotec.


  • asthma
  • dry powder inhaler
  • medication persistence
  • metred-dose inhaler
  • treatment efficacy


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