Consensus quality statements on implementing an inhaler regimen switch in respiratory diseases

Aim: To develop global expert consensus quality statements defining when inhaler regimen switching is appropriate, who should be involved, and key activities for implementation. Context: Clinicians and other decision-makers face situations (clinical and non-clinical, e.g. cost, environmental targets) that could prompt inhaler regimen switching, which can have unintended consequences. Description of change and justification: This consensus convened respiratory disease experts in primary care (general practitioner, pharmacist), secondary care (pulmonologists, nurses), health economics, and patient experts. Using a nominal group technique, experts generated consensus statements in response to questions on inhaler regimen switching. Who should be involved in decision-making and implementation? In what circumstances are inhaler switches appropriate/non-appropriate? What essential activities and timings are required to implement a successful switch? Responses were rated 1–7 (not at all important–extremely important). Strategy for change: This consensus states that inhaler regimen switches should be initiated and implemented by healthcare professionals experienced in inhaler prescribing. Highly rated circumstances for appropriate inhaler switching were inhaler technique errors and inadequate disease control due to symptoms/exacerbations (mean 6.25, 6.13, 6.13). No patient consultation, no training/education, no consent, patient prefers not to switch, and clinical stability were highly rated circumstances for non-appropriate switching (mean 7.0, 6.9, 6.6, 6.5, 6.5). Figure 1 presents a checklist of essential activities to implement a successful inhaler switch, requiring an estimated median of 35 minutes of clinical time per patient. Impact of change: This consensus provides clinicians and other decision-makers with practical guidance on who should initiate inhaler regimen switches and how they should be implemented to ensure they are effective, safe and sustainable. Lessons learned: Inhaler regimen switches must be expert-led and justified to patients. When setting healthcare policies, decision-makers should account for the clinical time and capacity required for successful inhaler switching, and the complexity of implementation at scale.