title: Asthma and COPD: Interchangeable use of inhalers. A document of Italian Society of Allergy, Asthma and Clinical Immmunology (SIAAIC) & Italian Society of Respiratory Medicine (SIMeR).
abstract: Prescription cost-containment measures are increasing in many European countries and, as more inhaler devices become available, there may be pressure to switch patients from reference inhaled medication to cheaper generic inhaled drugs. Indeed, in some countries, such a substitution is mandated by current regulations, and patients who do not accept the substitution have to pay the difference in cost. Generic inhaled drugs are therapeutically equivalent to original branded options but may differ in their formulation and inhalation device. This new situation raises questions about the potential impact of switching from branded to generic inhaled medications in patients with asthma or chronic obstructive pulmonary disease (COPD), with or without their consent, in countries where this is permitted. Acquisition cost savings from a substitution could be offset by costs related to deterioration in asthma control or worsening in COPD outcomes if the patient is unable or unwilling to use the inhaler device properly. Non-adherence to therapy and incorrect inhaler usage are recognised as major factors in uncontrolled asthma and worsening of COPD outcomes. Switching patients to a different inhaler device may exacerbate these problems, particularly in patients who disagree to switch. Where switching is permitted or mandatory, it is crucial that the reason for switching has been properly explained to the patient and adequate instruction for operating correctly the inhaler have clearly been provided.
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy. Electronic address: federico.lavorini@unifi.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
authors.affiliation: Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Braido
authors.affiliation: Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Baiardini
authors.affiliation: Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.affiliation: Respiratory and Allergy Diseases Clinic, DIMI, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Giorgio Walter
authors.initials: GW
authors.lastname: Canonica
mesh_terms: D001249:Asthma / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D057915:Drug Substitution; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007880:Legislation, Drug; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
chemical_list: D001993:Bronchodilator Agents; D016568:Drugs, Generic
keywords: Adherence; Asthma; COPD; Generics; Inhalers; Switching