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Survey of pharmacists’ attitudes towards interchangeable use of dry powder inhalers

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Abstract

Background

It is a common cost-containment practice in some countries to dispense a cheaper, generic version of a prescribed medication. This presents few problems for most medications. However, dry powder inhalers used in asthma and COPD vary markedly in design and method of operation, so generic substitution may not be acceptable to patients or healthcare professionals. Patients dispensed an unfamiliar device in which they have received no training, risk poor inhalation technique with the potential for inadequate dosing and loss of disease control.

Objective

To assess the views of pharmacists towards interchangeable use of dry powder inhalers.

Setting

Community pharmacists in Australia, Canada, France, Germany, and the UK.

Method

Following exploration of the key issues with international opinion leaders in respiratory management, a structured web questionnaire was developed for use in computer assisted web interviews. Fieldwork was carried out in March and April 2005. Main outcome measure: Responses to the web questionnaire were analysed by percentage of respondents or by mean or median score, as appropriate to the question.

Results

A total of 254 pharmacists were included in the study. Just 6% of pharmacists considered that dry powder inhalers are interchangeable, with a high level of concern shown about interchangeable use (median score of 6 on a scale of 1, not at all concerned, to 7, extremely concerned). Patient confusion was the main concern, expressed by 77% of respondents. Pharmacists also envisaged substitution having an adverse impact on pharmacy stock levels (72%), patient device handling (70%), pharmacist workload (63%), patient compliance (56%) and outcomes for the patient (51%), with pharmacists in Germany having a particularly negative view and those in France generally the most positive. Despite the generally negative view of pharmacists about interchangeable use of dry powder inhalers, overall only 22% would contact the prescribing physician often/very often for approval of the substitution.

Conclusion

The study showed that only a small minority of pharmacists believe that dry powder inhalers can be used interchangeably, with the majority concerned about generic substitution of these products. Pharmacists in Germany were particularly negative about the interchangeable use of dry powder inhalers.

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References

  1. Chrystyn H. Do patients show the same level of adherence with all dry powder inhalers? Int J Clin Pract 2005;59(Suppl 149):19–25

    Article  Google Scholar 

  2. Labris NR, Dolovich MB. Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications. J Clin Pharmacol 2003;56:600–12

    Article  Google Scholar 

  3. Gustafsson P, Taylor A, Zanen P, Chrystyn H. Can patients use all dry powder inhalers equally well? Int J Clin Pract 2005;59(Suppl 149):13–8

    Article  Google Scholar 

  4. Buchanan A, Pinnock H, Barnes J et al. Generic prescribing of breath actuated and dry powder inhalers in the UK. Prim Care Respir J 2002;11:95

    Google Scholar 

  5. Bisgaard H. Future options for aerosol delivery to children. Allergy 1999;54:97–103

    PubMed  Google Scholar 

  6. Taylor A, Gustafsson P. Do all dry powder inhalers show the same pharmaceutical performance?. Int J Clin Pract 2005;59(Suppl 149):7–12

    Article  Google Scholar 

  7. Pritchard JN. The influence of lung deposition on clinical response. J Aerosol Med 2001;14(S1):S19–S26

    Article  PubMed  CAS  Google Scholar 

  8. Bateman ED, Silins V, Bogolubov M. Clinical equivalence of salmeterol/fluticasone propionate in combination (50/100 mcg twice daily) when administered via a chlorofluorocarbon-free metered dose inhaler or dry powder inhaler to patients with mild-to-moderate asthma. Respir Med 2001;95:136–46

    Article  PubMed  CAS  Google Scholar 

  9. BTS/SIGN (British Thoracic Society/Scottish Intercollegiate Guidelines Network). British guideline on the management of asthma. Thorax 2003;58(suppl 1):i1–i94

    Google Scholar 

  10. GINA (Global Initiative for asthma). Pocket guide for asthma management and prevention. http://www.ginasthma.com/Guidelineitem.asp?l1=2&l2=1&intId=988

  11. Thomas M, Williams AE. Are outcomes the same with all dry powder inhalers? Int J Clin Pract 2005;59(Suppl 149):33–5

    Article  Google Scholar 

  12. Price D. Do healthcare professionals think that dry powder inhalers can be used interchangeably? Int J Clin Pract 2005;59(Suppl 149): 26–9

    Article  Google Scholar 

  13. Booker R. Do patients think that dry powder inhalers can be used interchangeably? Int J Clin Pract 2005;59(Suppl 149): 30–2

    Article  Google Scholar 

  14. Barnes PJ, Jonsson B, Klim JB. The costs of asthma. Eur Respir J 1996;9:636–42

    Article  PubMed  CAS  Google Scholar 

  15. Hoskins G, McCowan C, Neville RG et al. Risk factors and costs associated with an asthma attack. Thorax 2000;55:19–24

    Article  PubMed  CAS  Google Scholar 

  16. Adams WP, Puchikian G, Taylor AS, Patel RM, Burke GP, Williams RL. Regulatory aspects of modification to innovator bronchodilator metered dose inhalers and development of generic substitutes. J Aerosol Med 1994;7:119–34

    Article  PubMed  CAS  Google Scholar 

  17. Price D, Summers M, Zanen P. Could interchangeable use of dry powder inhalers affect patients?. Int J Clin Pract 2005;59(Suppl 149):3–6

    Article  Google Scholar 

  18. Wood KM, Boath EH, Mucklow JC, Blenkinsopp A. Changing medication: general practitioner and patient perspectives. Int J Phar Pract 1997;5:176–84

    Google Scholar 

  19. Zermansky AG, Petty DR, Raynor DK, Lowe CJ, Freemantle N, Vail A. Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice: a randomized controlled trial. Health Technol Assess 2002;6:1–86

    PubMed  CAS  Google Scholar 

  20. Vidgren M, Kärkkäinen A, Karjalainen P et al. Effect of powder inhaler design on drug deposition in the respiratory tract. Int J Pharm 1988;42:211–6

    Article  CAS  Google Scholar 

  21. Thorsson L, Edsbacker S. Less variability in lung deposition of budesonide via Turbuhaler than of fluticasone via Diskus/Accuhaler and pMDI in adults. Am J Respir Crit Care Med 2003;167(Suppl 7):A896

    Google Scholar 

  22. Kesten S, Zive K, Chapman KR. Pharmacist knowledge and ability to use inhaled medication delivery systems. Chest 1993;104:1737–42

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. GlaxoSmithKline, Greenford Road, Greenford, Middlesex, UK

    Angela E. Williams

  2. School of Pharmacy, University of Bradford, Bradford, UK

    Henry Chrystyn

Authors
  1. Angela E. Williams
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  2. Henry Chrystyn
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Correspondence to Henry Chrystyn.

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Williams, A.E., Chrystyn, H. Survey of pharmacists’ attitudes towards interchangeable use of dry powder inhalers. Pharm World Sci 29, 221–227 (2007). https://doi.org/10.1007/s11096-006-9079-6

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  • DOI: https://doi.org/10.1007/s11096-006-9079-6

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