Real-world Study Characterizing Patients Prior to Receiving Albuterol Multidose Dry Powder Inhaler or Short-acting β2-Agonist Via Pressurized Metered-Dose Inhalers for Asthma and COPD in the United States

RATIONALE: Short-acting β₂ agonists (SABA) are administered primarily using pressurized metered-dose inhalers (pMDIs). Albuterol multidose dry powder inhaler (MDPI; ProAir RespiClick^®), a novel, breath-actuated device, eliminates hand-breath coordination required of pMDIs. A gap exists in understanding real-world differences in patients prior to receiving albuterol MDPI or SABA pMDI.

METHODS: This retrospective study used a large, nationally representative managed care database including asthma (aged ≥4 years) and chronic obstructive pulmonary disease (COPD; aged ≥40 years) patients receiving ≥1 albuterol MDPI or any SABA pMDI prescription between April 2015 and March 2016. Baseline patient demographics, provider specialty, disease severity (GINA step level or COPD severity score), comorbidities, and healthcare resource use (HCRU) were assessed over 6 months before first SABA fill date.

RESULTS: The study included 2140 albuterol MDPI (n=1244 asthma; n=896 COPD) and 230,822 SABA pMDI (n=172,911 asthma; n=57,911 COPD) patients. At baseline, albuterol MDPI patients were elderly, more likely to be female (asthma only), had higher baseline comorbidities, more respiratory specialty visits, and higher respiratory-related ambulatory visits (all P<0.05 vs SABA pMDI); no difference with inpatient or emergency HCRU was observed. Greater proportions of albuterol MDPI versus SABA pMDI users had more severe disease at baseline (asthma: 12.71% vs 8.13%; COPD: 28.57% vs 23.37%; P<0.05), with more asthma exacerbations (7.64% vs 1.40%; P<0.05) but similar COPD exacerbations (19.08% vs. 21.30%, P=0.108).

CONCLUSIONS: More albuterol MDPI patients saw respiratory specialists and had severe disease at baseline versus SABA pMDI patients. Further research may elucidate how patient characteristics (eg, disease severity, comorbidities) influence SABA inhaler choice.