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Asthma care row as patients shifted to cheap inhalers

Patients with asthma are being shifted en masse from one inhaler to another to save cash in a procedure which a new analysis shows is seriously damaging patient care.

Patients with asthma are being shifted en masse from one inhaler to another to save cash in a procedure which a new analysis shows is seriously damaging patient care.


PCTs were accused of being 'obsessed' with cutting costs by switching patients' inhalers without even offering them a consultation with a doctor.

Patients who were switched were only a quarter as likely to have satisfactory symptom control as those allowed to remain on their inhaler, and more than twice as likely to suffer treatment failure.

A further qualitative study from the same authors found patients who were switched felt 'angry', 'upset' and 'shocked', and experienced a 'loss of trust in their GP'.

GP respiratory experts said the practice was becoming 'increasingly widespread' and should be 'condemned by the medical profession' (see link).

The research exposing the practice of inhaler switching came as NICE provisionally recommended expensive combined inhalers for childhood asthma, following on from similar draft advice in adults published last month (see link).

The analysis of 844 patients, presented last week at an American Thoracic Society conference in San Francisco, found that patients who were switch-ed were also twice as likely as controls to seek a subsequent consultation.

Study leader Dr Mike Thomas, respiratory research fellow at the University of Aberdeen and a GP in Minchinhampton, Gloucestershire, warned: 'We'd advise mass switching should only occur at a face-to-face consultation and with full understanding and consent from patients, otherwise it may jeo- pardise asthma control and patient trust.'

Fellow researcher Professor Henry Chrystyn, professor of clinical pharmacy at the University of Bradford, said: 'We seem to be getting obsessed with bringing down item costs when actually our study shows the more important healthcare costs are actually higher when patients are switched to cheaper devices without consultations.'

Dr David Reade, a GP in Liverpool with a special interest in asthma, said: 'I can't believe anyone could do this sort of wholesale swapping without patient consultations, particularly for asthma, where it is exacerbated by stress.'

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