OBJECTIVES

: There are currently 99 inhalation devices in the UK market for respiratory diseases. These products are either monotherapy or fixed-dose combinations of beta-agonists, anti-muscarinics, mast-cell stabilizers and inhaled corticosteroids (ICS). This research evaluates the potential challenges in choosing the right device by physicians and patients.

METHODS

: Publically-available information on devices from https://www.rightbreathe.com was screened (up to 01/17/2018).

RESULTS

: According to the British Thoracic Society/Scottish Intercollegiate Guidelines Network 2016 guidelines for asthma in adults, which suggests initiating low dose ICS, there are currently 30 ICS monotherapies available with five different actives (beclomethasone, budesonide, ciclesonide, fluticasone, and mometasone), and three different types of devices (pressurized metered-dose inhaler (pMDI), breath-actuated pMDI, and dry powder inhaler (DPI). This is followed by add-on therapy of inhaled long-acting beta-agonist (LABA) as a fixed-dose combination, and there are 28 ICS + LABA combinations with five different combinations of actives (beclomethasone + formoterol, budesonide + formoterol, fluticasone + formoterol, fluticasone + salmeterol, and fluticasone + vilanterol), and two different type of devices (pMDI and DPI). There is currently a lack of evidence from randomised controlled clinical trials (RCT) to support overall efficacy difference between the different combinations. Clearly there are pharmacological and device performance advantages with certain combinations (fluticasone and formoterol – Tamm 2012). This has led to more innovative approaches to determining the risk-benefit profile between therapies, such as the Salford Lung Study.

CONCLUSIONS

: In the age of evidence-based medicine, a wide selection is usually considered beneficial in terms of giving physicians and patients more options. However, the large number of available combination asthma therapies without RCT data to support selection, offers challenges for physicians to choose the right therapy, not taking into account the inherent patient variabilities in lung function and disease state. In conclusion, a more pragmatic and real world approach is needed to acquire the necessary evidence.