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RESEARCH PRODUCT

What drives inhaler prescription for asthma patients? Results from a real-life retrospective analysis

Pierluigi PaggiaroFulvio BraidoA. GentileFederico LavoriniA. SoldiV. PegoraroNicola ScichiloneF. Di MarcoPaola RoglianiGirolamo PelaiaG.w. CanonicaA. BiancoAngelo CorsicoPierachille SantusFrancesco Blasi

subject

Pulmonary and Respiratory Medicinemedicine.medical_specialtyMultivariate analysisSettore MED/10 - Malattie Dell'Apparato RespiratorioGeneral practitioner03 medical and health sciencesdry powder inhaler0302 clinical medicineInhalersAdrenal Cortex HormonesAdrenergic beta-2 Receptor AntagonistsAsthma controlGeneral practitionersAdministration InhalationRetrospective analysisMedicine030212 general & internal medicineMetered Dose InhalersMedical prescriptionAsthmaRetrospective Studiesbusiness.industryInhalerdry powder inhalersInhalerOdds ratiomedicine.diseaseConfidence intervalAsthmaPressurised metered-dose inhalerAsthma; dry powder inhalers; General practitioners; Inhalers; Pressurised metered-dose inhalers; Respiratory specialistsPrescriptions030228 respiratory systemRespiratory specialistsInhalationDelayed-Action PreparationsEmergency medicineAdministrationPressurised metered-dose inhalersbusinessAsthma; dry powder inhalers; General practitioners; Inhalers; Pressurised metered-dose inhalers; Respiratory specialists; Administration Inhalation; Adrenal Cortex Hormones; Adrenergic beta-2 Receptor Antagonists; Asthma; Delayed-Action Preparations; Retrospective Studies; Dry Powder Inhalers; Metered Dose Inhalers; Prescriptions

description

Abstract Background The choice of inhaler device for asthma patients depends upon multiple attributes. We investigated factors that may drive general practitioners (GPs) and respiratory specialists in the prescription of inhaler devices for asthma patients who initiated inhalation therapy. Methods We retrospectively analysed prescriptions by GPs and respiratory specialists to asthma patients commencing inhaled corticosteroid/long-acting β2-agonist combination therapy available as both pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Patient characteristics were compared by device and multivariate analysis was used to model the likelihood of receiving a pMDI as opposed to a DPI in order to identify drivers for prescription. A sample of the respiratory specialists completed an ad-hoc survey of their perceived success in achieving asthma control in their patients and barriers to attaining full control. Results Prescription of a particular inhaler device was unrelated to the characteristics of the patients. Multivariate analysis revealed that the main driver for the choice of inhaler device choice was the medication (Odds Ratio and 95% Confidence Interval, respectively for GPs and specialists: 0.19 [0.16–0.23]; 0.17 [0.08–0.37]). Specialists perceived asthma as being inadequately controlled in 41% of their patients, and considered patients' difficulties in using DPIs and pMDIs as instrumental in this, citing a need for a novel, more effective inhaler technology. Conclusion Physicians choose inhaler devices according to the prescribed drugs and not to the characteristics of the individual patient. This may reflect a lack of confidence in existing inhaler devices and underlines the need for technologies, which are more reliable and easier to use by patients.

yearjournalcountryeditionlanguage
2020-01-01
10.1016/j.rmed.2020.105937http://hdl.handle.net/11567/1026082