title: Switching treatments in COPD: implications for costs and treatment adherence.
abstract: Inhaled therapy is key to the management of chronic obstructive pulmonary disease (COPD). New drugs and inhalers have recently been launched or will soon become available, and the expiry of patent protection covering several currently used inhaled bronchodilators and corticosteroids will be accompanied by the development of bioequivalent, generic inhaled drugs. Consequently, a broader availability of branded and generic compounds will increase prescription opportunities. Given the time course of COPD, patients are likely to switch drugs and inhalers in daily practice. Switching from one device to another, if not accompanied by appropriate training for the patient, can be associated with poor clinical outcomes and increased use of health care resources. In fact, while it seems reasonable to prescribe generic inhaled drugs to reduce costs, inadequate use of inhaler devices, which is often associated with a poor patient-physician or patient-pharmacist relationship, is one of the most common reasons for failure to achieve COPD treatment outcomes. Further research is needed to quantify, as in asthma, the impact of inappropriate switching of inhalers in patients with COPD and show the outcomes related to the effect of using the same device for delivering inhaled medications.
authors.affiliation: Respiratory and Allergy Diseases Clinic, Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Braido
authors.affiliation: Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Lavorini
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, Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Baiardini
authors.affiliation: Respiratory and Allergy Diseases Clinic, Department of Internal Medicine, University of Genoa, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Giorgio Walter
authors.initials: GW
authors.lastname: Canonica
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D057915:Drug Substitution / Q000191:economics*; D058995:Dry Powder Inhalers / Q000191:economics; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D055118:Medication Adherence; D036501:Metered Dose Inhalers / Q000191:economics; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
keywords: dry powder inhaler; inhaled corticosteroids; inhaled therapy; long-acting antimuscarinic agents; long-acting β2 agonists; metered-dose inhalers