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Cost saving of switching to equivalent inhalers and its effect on health outcomes
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  • Published on:
    Reply to 'Patient engagement is vital'
    • Chloe I Bloom, Academic Respiratory Consultant Imperial College London
    • Other Contributors:
      • Ian Douglas, Professor of Pharmacoepidemiology
      • Jack Olney, Health economics center manager
      • Grainne d'Ancona, Principal Pharmacist
      • L Smeeth, Professor of Clinical Epidemiology
      • Jennifer K Quint, Reader in Respiratory Epidemiology

    We thank John White for his letter and wholeheartedly agree that switching of inhalers, for any reason, should solely be done after assessing the suitability of the switch for each individual patient and with full engagement and agreement of the patient. We also thank him for further raising the issue of the environmental impact of inhalers. As he points out, our study found that following a switch of inhalers, there was no deterioration in disease control. It is worth noting that this improvement was found with all switches we assessed, including those switching from MDIs (containing propellants containing potent greenhouse gases) to DPIs (containing low global warming potential). We agree that a potential reason for improved disease control was an interaction between clinician and patient, also explaining the increased adherence. We too have anecdotally come across patients for which switching inhalers for financial reasons appeared to be detrimental to their health; this was the impetus for the study. The study findings were perhaps unexpected, but as epidemiologists, feel this shows the relevance of considering the whole population at risk, and as clinicians, the importance of tailoring interventions to the individual.

    Conflict of Interest:
    None declared.
  • Published on:
    Patient engagement is vital
    • John White, Consultant Physician, Respiratory Medicine and BTS co-chair BTS/SIGN national asthma guideline York NHS Foundation Trust

    This paper provides welcome reassurance that switching of inhalers can be carried out not only without risk of deterioration but that improvements in disease control may be seen. My supposition is that this is due to the interaction between clinician and patient to discuss the switch that stimulates increased engagement in the patient leading to better outcomes. Whatever the mechanism this paper is timely with the BBC just today featuring an article on the environmental impact of inhalers and the need to reduce the NHS carbon footprint by choosing more environmentally friendly options.
    The latest BTS/SIGN national asthma guideline includes new information on this and highlights opportunities to recycle pMDIs where possible.
    However, a word of caution on inhaler switching may be in order. Although only anecdotal evidence from my lengthy clinical practice I have on several occasions met patients from different surgeries who have had their regular inhaled therapies repeat prescription changed without discussion, never mind agreement - usually on cost saving rather than environmental reasons - leading at best to loss of confidence in their local surgery and at worst loss of control of their asthma such that an attack was precipitated leading to hospital admission. This was not only a significant risk for the individual but far more costly than the anticipated s...

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    Conflict of Interest:
    None declared.