Published in
The Journal of the American Medical Association, American Medical Association
Content
In Reply Drs Kraut, Babenko, and Sun bring up important points in response to our recent Perspective titled “Reducing Inhaler-Related Greenhouse Gas Emissions.” While we agree that many patients at Veterans Affairs hospitals were switched from fluticasone-salmeterol back to budesonide-formoterol or another inhaler, this occurred in only 14.6% of patients included in the above-mentioned study. The study did not provide detailed information on the patients’ underlying diagnoses (eg, asthma vs chronic obstructive pulmonary disease [COPD]). In the recently published follow-up study, Rabin et al reported that those switched to fluticasone-salmeterol dry-powder inhaler had increased hospitalizations and emergency department visits for pneumonia and required more courses of prednisone. Approximately 70% of the patients in this cohort had a COPD diagnosis, yet they received treatment with fluticasone-salmeterol, which is not recommended in current COPD guidelines and has been associated with an increased risk of pneumonia in patients with COPD. Similar outcomes were noted in the subgroup analysis, which included those with asthma. This study highlights the need for implementation of guideline-recommended treatment for both asthma and COPD and careful consideration of the potential risks and benefits specific to those being switched to lower-emission inhalers.
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