title: Effectiveness of same versus mixed asthma inhaler devices: a retrospective observational study in primary care.
abstract: OBJECTIVE
  Correct use of inhaler devices is fundamental to effective asthma management but represents an important challenge for patients. The correct inhalation manoeuvre differs markedly for different inhaler types. The objective of this study was to compare outcomes for patients prescribed the same inhaler device versus mixed device types for asthma controller and reliever therapy.
  
  
  METHODS
  This retrospective observational study identified patients with asthma (ages 4-80 years) in a large primary care database who were prescribed an inhaled corticosteroid (ICS) for the first time. We compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for ICS controller and salbutamol reliever versus mixed devices (BAI for controller and pressurised metered-dose inhaler [pMDI] for reliever). The 2-year study included 1 baseline year before the ICS prescription (to identify and correct for confounding factors) and 1 outcome year. Endpoints were asthma control (defined as no hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory tract infection) and severe exacerbations (hospitalisation or oral corticosteroids for asthma).
  
  
  RESULTS
  Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15; 95% confidence interval [CI], 1.02-1.28) and recorded significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95% CI, 0.68-0.93) than those prescribed mixed devices (n=5,452).
  
  
  CONCLUSIONS
  These findings suggest that, when possible, the same device should be prescribed for both ICS and reliever therapy when patients are initiating ICS.
authors: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors: David
authors: D
authors: Price
authors: Henry
authors: H
authors: Chrystyn
authors: Alan
authors: A
authors: Kaplan
authors: John
authors: J
authors: Haughney
authors: Miguel
authors: M
authors: Román-Rodríguez
authors: Annie
authors: A
authors: Burden
authors: Alison
authors: A
authors: Chisholm
authors: Elizabeth V
authors: EV
authors: Hillyer
authors: Julie
authors: J
authors: von Ziegenweidt
authors: Muzammil
authors: M
authors: Ali
authors: Thys
authors: T
authors: van der Molen