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Prescribing different inhalers linked with reduced asthma control

Prescribing different types of inhaler devices in the same patient may lead to worse asthma control, say GP researchers.

In a study of data from 8,880 patients who had been prescribed an inhaled corticosteroid for the first time, those who received the same type of device for that and their reliever therapy were 15% more likely to achieve asthma control than those with different inhaler types.

Those patients with the same devices – a breath-actuated inhaler for both inhaled corticosteriod controller and salbutamol reliever – also recorded a significant difference of 21% in severe exacerbation rates than those with two different inhalers.

The analysis, done on patient records from the General Practice Research Database, found 3,428 patients who were prescribed Easi-Breathe inhalers for both beclomethasone and salbutamol and 5,452 who were prescribed a pressured metered dose salbutamol inhaler in addition to an Easi-Breathe beclomethasone device.

Around a quarter of patients in the study were children aged four to 11 years, the researchers report in Allergy, Asthma and Immunology Research.

The results also showed that more patients in the same device cohort consumed a mean daily ICS dose of >400 ?g/day, and fewer used no salbutamol during the year after prescription.

There were no differences between the two groups in the rate of hospital admissions for respiratory problems.

The researchers said that wherever possible the same device should be prescribed for both inhaled corticosteroid and reliever therapy.

Study leader Professor David Price, professor of respiratory medicine at the University of Aberdeen and a GP in Norwich, said the differences found in the study most likely result from the impact of two different devices on beclomethasone inhaler technique.

‘Very possibly because the need to use different breathing patterns with the two devices adversely impacted ICS inhaler technique', he added.

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