Do healthcare professionals think that dry powder inhalers can be used interchangeably?

Abstract

It is important to assess the attitudes of healthcare professionals to the interchangeable use of dry powder inhalers, as there is the potential for this to occur more frequently in the future. A survey of healthcare professionals in the UK found that 87% were concerned about potential problems arising from prescriptions that do not specify the device to be dispensed, and 46% were aware of actual incidents in which patients received an unfamiliar inhaler, including patient confusion, ineffective inhaler technique and the need to reissue prescriptions. In another survey conducted among 427 primary and secondary care physicians in Germany, Netherlands, UK and USA, one third of the physicians considered the device before considering the chemical entity within a class of treatments and over half the respondents reported problems with the device as one of the main reasons for switching inhaled therapy. In a survey conducted in Australia, Canada, France, Germany and UK, over 90% of the 726 physicians interviewed thought that interchangeable use of dry powder inhalers would have a negative impact on patient compliance and device handling and on willingness to use the inhaler if the patient was not involved in the choice. In total, 79% of physicians thought that substitution of a patient's regular dry powder inhaler with another could have a negative impact on asthma control. The majority of physicians (95%) were opposed to substitution of one dry powder inhaler for another if the pharmacist does not consult the patient or physician. A majority (86%) were concerned that switching between dry powder inhalers would have an adverse impact on workload. Only 9% of physicians thought that dry powder inhalers were interchangeable, with almost eight out of 10 (79%) considering that there should be official recognition that they are not interchangeable. In conclusion, a number of surveys among healthcare professionals have shown that they believe patient involvement in treatment choice to be essential for adherence to therapy. Dry powder inhalers were perceived as different and not interchangeable, with physicians opposed to substitution of one dry powder inhaler by another without consultation with the patient or physician. Consequently, physicians are in favour of official recognition that dry powder inhalers are not interchangeable, with any cost benefits likely to be outweighed by the need for additional consultations and prescriptions.