Budesonide-Formoterol Metered-Dose Inhaler vs Fluticasone-Salmeterol Dry-Powder Inhaler.

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Environmental Health

Background:

• Metered-dose inhalers (MDIs) contribute to greenhouse gas emissions.
• Propellant-free dry-powder inhalers (DPIs) offer an environmentally friendly alternative.
• The clinical impact of switching from MDIs to DPIs for respiratory conditions is not fully understood.

Purpose of the Study:

• To assess clinical outcomes following a formulary change replacing budesonide-formoterol MDIs with fluticasone-salmeterol DPIs.
• To evaluate the impact on patients with chronic obstructive pulmonary disease (COPD) and asthma.
• To determine if the switch affected healthcare utilization and adverse events.

Main Methods:

• A within-person, self-controlled case series (SCCS) and a matched observational cohort study.
• Utilized data from the US Veterans Affairs health care system (January 2018-December 2022).
• Included patients prescribed combination inhalers before and after the July 2021 formulary change.

Main Results:

• Over 260,000 patients switched inhaler types.
• The switch to fluticasone-salmeterol DPI was associated with increased prednisone fills, emergency department visits, and hospitalizations (all-cause, respiratory, pneumonia).
• The cohort study showed no difference in mortality but increased hospitalizations at 180 days post-switch.

Conclusions:

• The Veterans Health Administration (VHA) formulary transition to DPIs increased healthcare utilization.
• Findings suggest potential patient harm and the need to re-evaluate the policy.
• Further research is needed to understand the long-term implications of this inhaler switch.