The Impact of a Forced Non-Medical Switch of Inhaled Respiratory Medication Among Patients with Asthma or Chronic Obstructive Pulmonary Disease: A Patient Survey on Experience with Switch, Therapy Satisfaction, and Disease Control
Received 13 December 2019
Accepted for publication 26 June 2020
Published 20 August 2020 Volume 2020:14 Pages 1463—1475
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Ileen Gilbert,1 Keiko Wada,2 Chakkarin Burudpakdee,2 Chirag Ghai,2 Laren Tan3
1AstraZeneca, Wilmington, DE, USA; 2IQVIA, Falls Church, VA, USA; 3Loma Linda University Health, Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda, CA, USA
Correspondence: Ileen Gilbert Email firstname.lastname@example.org
Purpose: Budesonide/formoterol pressurized metered-dose inhaler (pMDI) was removed from a Medicare Part D formulary, and patients switched to fluticasone-based dry powder inhaler (DPI) therapies. This study describes the experience, satisfaction, and disease control among patients with asthma or chronic obstructive pulmonary disease (COPD) who switched due to removal from the formulary.
Patients and Methods: A patient survey was conducted among adults with asthma or COPD who used budesonide/formoterol pMDI for ≥ 3 months prior to the formulary block and the new medication for ≥ 3 weeks after switching, recruited by providers in a research panel. Survey comprised both validated instruments (PASAPQ, OEQ, ACQ-6, and CAT) and stand-alone questions. Patient characteristics, switch experience, device and treatment satisfaction, onset of effect, and disease control were compared between disease (asthma and COPD) and medication (once and twice daily) cohorts. Minimal significance for group differences: P≤ 0.05.
Results: Among 100 patients, 93% received communication from their doctor or nurse about the switch and 73% received training on using the new inhaler. Patients used their new treatment for an average of 7 months prior to completing the survey. Patient satisfaction with the new therapy was high (PASAPQ; mean overall satisfaction: 6.2 for asthma; 6.0 for COPD; P=0.338). However, asthma was not well controlled (ACQ-6) in 62% of patients with asthma, and 56% of patients with COPD reported high/very high impact of their illness on their lives (CAT). Sixty-eight percent and 70% of patients with asthma and COPD, respectively, required reliever medication (≥ 3 puffs) most days during the week prior to the survey. There were no significant differences in disease control (ACQ-6, CAT) between once-daily and twice-daily treatments (P> 0.05 for both asthma and COPD).
Conclusion: Even when reporting satisfaction with their new medication, objective measures showed substantial morbidity, regardless of DPI device or dosing regimen.
Keywords: asthma, pulmonary disease, chronic obstructive, Medicare Part D, dry powder inhalers, metered dose inhalers, surveys, questionnaires