title: Retail sales of inhalation devices in European countries: so much for a global policy.
abstract: OBJECTIVE
  To evaluate the retail sales of pressurised metered-dose inhalers (pMDIs), dry-powder inhalers (DPIs) and liquids for nebulisation in 16 European countries.
  
  
  METHODS
  Retail sales data relating to pMDIs, DPIs and liquids for nebulisation delivering short- and long-acting bronchodilators, corticosteroids and combinations between 2002 and 2008 were obtained from the IMS sales database. The IMS database ensured that wholesalers' stock sales accurately matched that of retail pharmacies and included purchases by panel pharmacies directly from pharmaceutical manufacturers, specialist wholesalers and distribution cooperatives.
  
  
  RESULTS
  Mean inhaler retail sales (expressed as percentages of total sales) were 47.5% for pMDIs, 39.5% for DPIs and 13% for nebulisers. The distribution of inhaler sales differed significantly between the countries with pMDI sales greatest in the United Kingdom and Hungary compared to other countries, where DPI sales prevailed. Sales of nebulisation liquids were high in Italy. The pMDI was the most frequently prescribed inhaler for bronchodilators. In contrast, retail sales of DPIs were similar to those of pMDIs for inhaled corticosteroids, and higher in the case of inhalers with combined long-acting β(2)-agonist and corticosteroid.
  
  
  CONCLUSIONS
  We found a high degree of variability in inhaler prescription between European countries. Differing health policies, costs, health insurance issues, pharmaceutical/commercial aspects and prescribers' and patients' preferences may explain this variation. We suggest a need for more uniform, outcome-led inhaler prescribing practice across Europe to improve the efficacy and cost effectiveness of the treatment of obstructive airways diseases.
authors.affiliation: Department of Internal Medicine, Section of Immunoallergology, Respiratory Diseases and Cell Therapy, University of Florence, Florence, Italy. federico.lavorini@unifi.it
authors.forename: F
authors.initials: F
authors.lastname: Lavorini
authors.forename: C J
authors.initials: CJ
authors.lastname: Corrigan
authors.forename: P J
authors.initials: PJ
authors.lastname: Barnes
authors.forename: P R N
authors.initials: PR
authors.lastname: Dekhuijzen
authors.forename: M L
authors.initials: ML
authors.lastname: Levy
authors.forename: S
authors.initials: S
authors.lastname: Pedersen
authors.forename: N
authors.initials: N
authors.lastname: Roche
authors.forename: W
authors.initials: W
authors.lastname: Vincken
authors.forename: G K
authors.initials: GK
authors.lastname: Crompton
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D058995:Dry Powder Inhalers; D005060:Europe; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000600:supply & distribution; D009330:Nebulizers and Vaporizers / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000191:economics
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents