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Pressurized Metered-Dose Inhaler Versus Dry Powder Inhaler Adherence Among Individuals with Asthma and COPD
Dekel Shlomi1,2, Bernice Oberman3, Yehonatan Halevy1
1The Adelson School of Medicine, Ariel University, Ariel 4070000, Israel.
Advances in Respiratory Medicine
|October 28, 2025
Summary
Patients with asthma and COPD showed low adherence to inhalers. Dry powder inhalers (DPIs) were purchased more often than pressurized metered-dose inhalers (pMDIs), and once-daily DPIs improved adherence.
Area of Science:
- Respiratory Medicine
- Pharmacology
- Public Health
Background:
- Daily inhaler therapy with inhaled corticosteroids (ICS) and long-acting bronchodilators is central to managing asthma and COPD.
- Pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs) are the primary delivery devices.
- Previous studies indicate suboptimal adherence to these prescribed inhaler treatments.
Purpose of the Study:
- To investigate adherence differences between pMDIs and DPIs for combined ICS and long-acting β2-agonist (ICS + LABA) inhalers.
- To compare adherence between once-daily and twice-daily DPIs in a large, commercially unbiased cohort.
Main Methods:
- A historical prospective study included adult patients with asthma and/or COPD who obtained ICS + LABA inhalers between 2016 and 2019.
- Propensity score matching was employed to create comparable groups.
- Adherence was assessed by comparing the maximum number of pMDIs and DPIs purchased within any continuous 12-month period.
Main Results:
- Out of 36,998 matched patients, 15.9% used pMDIs.
- Significantly more DPIs (median [IQR] 3 [1, 8]) were purchased compared to pMDIs (1 [1, 4]) across all patient groups (p < 0.001).
- Once-daily DPIs demonstrated significantly better adherence than twice-daily DPIs.
Conclusions:
- DPIs, particularly once-daily formulations, show higher adherence rates compared to pMDIs for ICS + LABA therapy.
- Despite differences in device adherence, overall adherence to ICS + LABA inhalers remains low for patients with asthma and/or COPD.
- Highest adherence was noted in patients with asthma-COPD overlap.
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