Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy.
Respir Med. 2020 May;166:105937. doi: 10.1016/j.rmed.2020.105937. Epub 2020 Mar 20.
The choice of inhaler device for asthma patients depends upon multiple attributes. We investigated factors that may drive general practitioners (GPs) and respiratory specialists in the prescription of inhaler devices for asthma patients who initiated inhalation therapy.
We retrospectively analysed prescriptions by GPs and respiratory specialists to asthma patients commencing inhaled corticosteroid/long-acting β2-agonist combination therapy available as both pressurised metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Patient characteristics were compared by device and multivariate analysis was used to model the likelihood of receiving a pMDI as opposed to a DPI in order to identify drivers for prescription. A sample of the respiratory specialists completed an ad-hoc survey of their perceived success in achieving asthma control in their patients and barriers to attaining full control.
Prescription of a particular inhaler device was unrelated to the characteristics of the patients. Multivariate analysis revealed that the main driver for the choice of inhaler device was the medication (Odds Ratio and 95% Confidence Interval, respectively for GPs and specialists: 0.19 [0.16-0.23]; 0.17 [0.08-0.37]). Specialists perceived asthma as being inadequately controlled in 41% of their patients, and considered patients' difficulties in using DPIs and pMDIs as instrumental in this, citing a need for a novel, more effective inhaler technology.
Physicians choose inhaler devices according to the prescribed drugs and not to the characteristics of the individual patient. This may reflect a lack of confidence in existing inhaler devices and underlines the need for technologies, which are more reliable and easier to use by patients.
哮喘患者吸入器装置的选择取决于多个属性。我们研究了可能促使全科医生（GP）和呼吸专家为开始吸入治疗的哮喘患者处方吸入器装置的因素。
我们回顾性分析了 GP 和呼吸专家为开始使用可同时提供压力计量吸入器（pMDI）和干粉吸入器（DPI）的吸入皮质激素/长效β2-激动剂联合治疗的哮喘患者开具的处方。按装置比较患者特征，并进行多变量分析，以建立接受 pMDI 而非 DPI 的可能性模型，以确定处方的驱动因素。部分呼吸专家完成了一项关于他们在实现患者哮喘控制方面的成功和实现完全控制的障碍的临时调查。
特定吸入器装置的处方与患者的特征无关。多变量分析显示，选择吸入器装置的主要驱动因素是药物（GP 和专家的优势比和 95%置信区间分别为：0.19 [0.16-0.23]；0.17 [0.08-0.37]）。专家认为他们 41%的患者哮喘控制不足，并认为患者在使用 DPI 和 pMDI 方面存在困难，这是导致控制不足的原因之一，他们认为需要一种新型、更有效的吸入器技术。
医生根据处方药物而不是患者的个体特征选择吸入器装置。这可能反映出对现有吸入器装置缺乏信心，并强调需要更可靠、更易于患者使用的技术。
