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Budesonide inhaler device switch patterns in an asthma population in Swedish clinical practice (ASSURE)

Journal article
Authors Ann Ekberg-Jansson
I. Svenningsson
G. Stratelis
G. Telg
M. Thuresson
F. Nilsson
Published in International journal of clinical practice
Volume 69
Issue 10
Pages 1171-1178
ISSN 1368-5031
Publisher Blackwell Publishing Ltd
Publication year 2015
Published at Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Pages 1171-1178
Language en
Keywords budesonide, adult, asthma, clinical effectiveness, cohort analysis, controlled study, disease exacerbation, disease registry, dry powder inhaler, female, human, major clinical study, male, metered dose inhaler, observational study, outcome assessment, prescription
Subject categories Respiratory Medicine and Allergy


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. © 2015 John Wiley & Sons Ltd.

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