Real-life characteristics of asthma inhaler device use in South Korea

Abstract

Background and Aims: Historically, dry powder inhalers (DPIs) were considered to provide better airway distribution, easier identification of empty devices, and easier handling when compared to pressurized metered dose inhalers (pMDIs). Prior research into the major handling errors with inhaler device use has shown that errors result in comparable impairment of asthma control in both DPIs and pMDIs. Our own research has demonstrated that patients who are prescribed similar types of preventer inhaler devices to their reliever have better asthma control. Patients prescribed pMDI inhaled corticosteroid/long acting beta agonist relievers could benefit from switching from a DPI to a pMDI. The Health Insurance Review and Assessment (HIRA) database provides coverage of medical claims for over 50 million people in Korea and offers the opportunity to study asthma control on a national basis. The aim of this study was to provide a review of the possibilities of the Korean HIRA database in preparation for a study to investigate the effect on asthma control when patients switch inhaler types. Methods: Methodology from previous literature describing the HIRA database was analysed. We focused on the identification of asthma patients, their clinical characteristics (e.g. exacerbations, comorbidities), real-life medication switching behaviour, healthcare resource use (including medication) and associated costs. Results: Patient medical history could be constructed from primary and secondary diagnosis associated with individual database entries. Asthma exacerbations could be proxied by a prescription of acute oral corticosteroids, hospital admission or emergency room attendance associated with a diagnosis of asthma, lower respiratory infection or respiratory failure. Patients could be considered switch patients if they received a prescription of a pMDI after prescription of ≥2 DPI inhalers. Additional variables that were available included medication and hospitalisation cost. Conclusions: The HIRA database will allow studies analysing switch success of inhaler types in terms of persistence, asthma control and healthcare resource utilisation.