How Did a Hospital Formulary Change Affect Patients Who Use Asthma and Chronic Obstructive Pulmonary Disease Inhalers?

Sometimes clinicians are forced to change the drugs they prescribe because of formulary changes by health systems or insurers. In this study from the U.S. Veterans Health system, researchers examined whether one such change — replacing metered-dose budesonide-formoterol inhalers with dry-powder fluticasone-salmeterol inhalers because of lower cost — affected clinical outcomes in patients with chronic obstructive pulmonary disease (COPD; 70%) or asthma (30%).

During the 6 months after this change (compared with the previous 3 years), small but statistically significant increases occurred in emergency department (ED) visits, all-cause and respiratory hospitalizations, and pneumonia-specific hospitalizations. For example, among users of these i…