title: Budesonide inhaler device switch patterns in an asthma population in Swedish clinical practice (ASSURE).
abstract: BACKGROUND
  Dry powder inhaler (DPI) device switch in asthma treatment could potentially increase with the entrance of new devices. We examined the switch patterns of budesonide (BUD) DPI analogues available in Sweden.
  
  
  METHODS
  This observational real-life study linked primary healthcare medical records data from the Västra Götaland region to national Swedish registries, and included asthma patients (ICD-10-CM J45) prescribed BUD in a multidose DPI. Index date: first dispense of BUD DPI. Switch date: prescription of another BUD DPI device. Study outcomes (switch vs. non-switch) were exacerbations and prescription of short-acting β2 -agonists. Study period was 1 July 2005 to 31 October 2013.
  
  
  RESULTS
  Overall, 15,169 asthma patients were on treatment with BUD DPI; 1178 (7.35%) switched to another BUD DPI during the study. Pair-wise 1:1 matching of switchers vs. non-switchers resulted in two groups of 463 patients each (mean age 36 years, 55% female patients). A 25% higher exacerbation rate was seen postswitch (0.40 vs. 0.32; p = 0.047). Switchers were 4.5 year younger and had lower medication possession rate than non-switchers. Switch without primary healthcare visit did not differ between groups regarding consultations and exacerbations (no visit 4.96 and 0.90; visit 4.29 and 0.77, respectively). However, patients without primary healthcare visit at switch had significantly more outpatient hospital visits (2.01 vs. 0.81; p < 0.001).
  
  
  CONCLUSIONS
  Considering the low switch rate, asthma patients and physicians in Swedish general practice seem reluctant to switch to another BUD DPI device. Switch, especially without primary healthcare visit, was associated with decreased asthma control resulting in higher exacerbation rate and more outpatient hospital visits.
authors.affiliation: Angereds Närsjukhus, Angered, Sweden.|Institute for Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Ekberg-Jansson
authors.affiliation: Närhälsan FoU Primary Care, Region Västra Götaland, Vänersborg, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Svenningsson
authors.affiliation: Närhälsan Primary Care, Brastad, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Rågdell
authors.affiliation: AstraZeneca NordicBaltic, Södertälje, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Stratelis
authors.affiliation: AstraZeneca NordicBaltic, Södertälje, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Telg
authors.affiliation: Statisticon AB, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Thuresson
authors.affiliation: Närhälsan Primary Care, Kungshamn, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Nilsson
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage; D019819:Budesonide / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D058995:Dry Powder Inhalers; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D015994:Incidence; D008297:Male; D036501:Metered Dose Inhalers; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D019819:Budesonide