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Inhalers: to switch or not to switch? That is the question
  1. Anna Claire Murphy
  1. Pharmacy/Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK
  1. Correspondence to Dr Anna Claire Murphy, Pharmacy/Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK; anna.murphy{at}

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We know that there is an increasing prevalence of asthma and COPD worldwide, leading to increased inhaler use. Chapter 3 of the British National Formulary1 has grown significantly over the years in terms of the number of inhaler options. There are currently, in the UK, more than 20 different inhaler devices available, with over 118 possible combinations of drug and device to prescribe. The inhaler market has become very crowded, with patents expiring for some of the most widely used inhaled drugs. Several analogues of branded inhaled corticosteroids/long-acting β2-adrenoceptor agonists (ICS/LABA) fixed-dose combinations have entered the market with different inhaler devices, and longer-acting ‘me-too’ formulations have appeared. Incorrect or suboptimal patient technique in using inhalers has led to yet further inhaler devices being developed, and combination/triple inhalers have been launched to support patients.

Current clinical evidence suggests that, although existing inhaled therapy has the potential to control disease in most patients with asthma, control is often not achieved in practice.2 Suboptimal inhaler technique is the prominent reason for the lack of efficacy; no matter how good a drug or device is, it cannot be effective if the drug does not reach the targeted airways. Inhaler errors are associated with worsening in disease control, increased rate of exacerbations, increased healthcare resource consumption, and consequently increased healthcare expenditure.3–5 A recent systematic literature review and meta-analysis found that incorrect inhaler technique is common across devices, with up to 100% of patients demonstrating at least one error. Moreover, up to 92% of patients experience critical errors, that is, one that may impact the effectiveness of the delivered drug.6 While Chrystyn et al’s3 team found high critical error rates reported across all devices, their meta-analysis and systematic review highlighted significant gaps in knowledge regarding different inhalers and associated error …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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