Switching Inhalers: A Practical Approach to Keep on UR RADAR
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PRACTICAL APPROACH
Switching Inhalers: A Practical Approach to Keep on UR RADAR Alan Kaplan . Job F. M. van Boven
Received: July 29, 2020 / Accepted: September 23, 2020 The Author(s) 2020
ABSTRACT The choice of an inhaler device is often as important as the medication put in it to achieve optimal outcomes for our patients with asthma and/or COPD. With a multitude of drug–device combinations available, optimization of respiratory treatment could well be established by switching devices rather than changing or even augmenting pharmacological or non-pharmacological therapies. Importantly, while notable between-device differences in release A. Kaplan (&) Department of Family and Community Medicine, University of Toronto, Toronto, Canada e-mail: [email protected] A. Kaplan Primary Care Respiratory Research, Observational and Pragmatic Research Institute, Singapore, Singapore A. Kaplan Family Physician Airways Group of Canada, Toronto, Canada J. F. M. van Boven Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands J. F. M. van Boven Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
mechanism, particle size, drug deposition and required inspiratory flow exist, a patient uncomfortable with their device is unlikely to use it regularly and certainly will not use it properly. Switching requires a careful process and should not be done without patient consent. Switching devices entails several steps that need to be considered, which can be guided using the UR-RADAR mnemonic. It starts with (i) UncontRolled asthma/COPD (or UnaffoRdable device), followed by RADAR: (ii) review the patient’s condition (e.g. diagnosis, phenotype, co-morbidities) and address reasons for suboptimal control (e.g. triggers, smoking, non-adherence, poor inhaler technique) to be ruled out before switching; (iii) assess patient’s skills related to inhalation (e.g. inspiratory force); (iv) discuss inhaler switch options, patient preferences (e.g. size, daily regimen) and treatment goals; (v) allow patients input and use shared decision-making to decide final treatment choice, acknowledging individual patient skills, preferences and goals; and (vi) re-educate to the new device (at minimum, physical demonstration, verbal explanation and patient repetition, both verbally and physically) and prime the patient for the follow-up (i.e. explain the future patient journey, including multidisciplinary work flows with physicians, nurses and pharmacists).
Pulm Ther
Keywords: Adherence; Asthma; Change; COPD; Cost-effectiveness; Generic; Inhaler; Switch
Brand; Device;
Key Summary Points Switching requires a careful process and should not be done without patient consent. Switching devices in daily clinical practice can be guided using the UR-RADAR mnemonic. (i) UncontRolled asthma/COPD (or: UnaffoRdable device), followed by: (ii) Reassess the patient’s condition (e.g
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