After the Veterans Health Administration tweaked its formulary on an asthma and chronic obstructive pulmonary disease therapy, hospitalizations and emergency department visits increased, according to a recent study.
The research, published July 7 in JAMA Internal Medicine, analyzed clinical outcomes after the May 2021 formulary change from budesonide-formoterol metered-dose inhalers to fluticasone-salmeterol dry-powder inhalers.
Swapping metered-dose inhalers with propellant-free dry-powder ones could reduce healthcare-related greenhouse gas emissions, VHA researchers said, but the move was associated with adverse health outcomes.
After the formulary change, U.S. veterans who switched to the propellant-free dry-powder inhalers experienced a 5% increase in all-cause ED visits, a 8% increase in all-cause hospitalizations, a 10% increase in respiratory-related hospitalizations and a 24% increase in pneumonia-specific hospitalizations. There was no difference in mortality.
The researchers examined data from 260,268 patients who switched inhaler medicines following the formulary change, between Jan. 1, 2018, and Dec. 31, 2022.
“A key question raised by our study is whether the increased incidence of adverse outcomes among patients who switched to the dry-powder fluticasone-salmeterol inhaler was associated with the medication, the device, or other factors,” the researchers wrote. “The answer likely involves all 3 factors.”
Due to this potential harm, the study authors recommended a reevaluation of the policy change.
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