{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T19:38:07Z","timestamp":1790451487471,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Background: The core management of most individuals with asthma and COPD is daily treatment with inhalers such as inhaled corticosteroids (ICS) and long-acting bronchodilators. The two main types of inhalers used are pressurized metered-dose inhalers (pMDIs) and dry powder inhalers (DPIs). Different studies have shown low adherence to inhaler treatments among subjects with asthma and COPD. In this study, we explored the differences in adherence between pMDIs and DPIs of combined ICS and long-acting \u03b22-agonist inhalers (ICS + LABA) in a large cohort, free from commercial biases. Methods: In this historical prospective study, we included all adult subjects with asthma and\/or COPD who acquired at least one ICS + LABA inhaler between 2016 and 2019. We carried out propensity score matching and then compared the maximal number of pMDIs and DPIs purchased in any continuous 12 months during the study period. We also compared once-a-day DPIs with twice-a-day DPIs. Results: Of the 36,998 matched subjects, 5897 (15.9%) purchased pMDIs. The overall median [IQR] inhalers purchased for pMDIs and DPIs were 1 [1, 4] and 3 [1, 8], respectively; for subjects with asthma, 1 [1, 3] and 2 [1, 6]; for subjects with COPD, 1 [1, 3] and 3 [1, 10]; and for subjects with asthma\u2013COPD overlap, 2 [1, 7] and 6 [2, 12]. For all the comparisons, p &lt; 0.001. The once-a-day DPI group had a slight but significantly better adherence than the twice-a-day DPI group. Conclusions: For ICS + LABA therapy, the number of DPIs purchased was significantly greater than the number of pMDIs purchased, as well as the once-a-day DPI relative to the other DPIs. Overall, subjects with asthma and\/or COPD had low adherence to all inhalers, with the highest adherence observed among subjects with asthma\u2013COPD overlap.<\/jats:p>","DOI":"10.3390\/arm93050044","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T07:17:52Z","timestamp":1760512672000},"page":"44","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pressurized Metered-Dose Inhaler Versus Dry Powder Inhaler Adherence Among Individuals with Asthma and COPD"],"prefix":"10.3390","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4327-1084","authenticated-orcid":false,"given":"Dekel","family":"Shlomi","sequence":"first","affiliation":[{"name":"The Adelson School of Medicine, Ariel University, Ariel 4070000, Israel"},{"name":"Pulmonary Clinic, Dan-Petah-Tiqwa District, Clalit Health Services Community Division, 119 Rothschild St. Petah-Tiqwa, Ramat-Gan 4933355, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernice","family":"Oberman","sequence":"additional","affiliation":[{"name":"Research Unit, Dan-Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan 5120125, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1068-3382","authenticated-orcid":false,"given":"Yehonatan","family":"Halevy","sequence":"additional","affiliation":[{"name":"The Adelson School of Medicine, Ariel University, Ariel 4070000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiri","family":"Kushnir","sequence":"additional","affiliation":[{"name":"Research Authority, Rabin Medical Center, Beilinson Campus, Petah-Tiqwa 4941492, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadas","family":"Meir","sequence":"additional","affiliation":[{"name":"Research Unit, Dan-Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan 5120125, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Reichenberg","sequence":"additional","affiliation":[{"name":"Management, Dan-Petah-Tiqwa District, Clalit Health Services Community Division, Ramat-Gan 5120125, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1513\/AnnalsATS.201311-405PS","article-title":"The global burden of respiratory disease","volume":"11","author":"Ferkol","year":"2014","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_2","unstructured":"World Health Organization (2025, February 10). Chronic Obstructive Pulmonary Disease (COPD), Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd)."},{"key":"ref_3","unstructured":"GINA\u2014Global Initiative for Astma (2025, February 10). 2024 GINA Main Report. Available online: https:\/\/ginasthma.org\/2024-report\/."},{"key":"ref_4","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2025, February 10). 2025 GOLD Report, Available online: https:\/\/goldcopd.org\/2025-gold-report\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.chest.2016.03.041","article-title":"Systematic review of errors in inhaler use: Has patient technique improved over time?","volume":"150","author":"Sanchis","year":"2016","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1093\/jphsr\/rmad032","article-title":"The impact of pharmacist-guided inhaler technique education on chronic obstructive pulmonary disease and asthma patients","volume":"14","author":"Cohen","year":"2023","journal-title":"J. Pharm. Health Serv. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12931-017-0710-y","article-title":"Critical inhaler errors in asthma and COPD: A systematic review of impact on health outcomes","volume":"19","author":"Usmani","year":"2018","journal-title":"Respir. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Poplicean, E., Cri\u0219an, A.F., Tudorache, E., Hogea, P., Mladin, R., and Oancea, C. (2024). Unlocking Better Asthma Control: A Narrative Review of Adherence to Asthma Therapy and Innovative Monitoring Solutions. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226699"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/s41533-017-0016-z","article-title":"Device errors in asthma and COPD: Systematic literature review and meta-analysis","volume":"27","author":"Chrystyn","year":"2017","journal-title":"Npj Prim. Care Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1002\/nop2.357","article-title":"Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care","volume":"6","author":"Lindh","year":"2019","journal-title":"Nurs. Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.pulmoe.2019.05.012","article-title":"COPD: Analysing factors associated with a successful treatment","volume":"26","author":"Teixeira","year":"2020","journal-title":"Pulmonology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.pulmoe.2020.01.005","article-title":"Is adherence to treatment influenced by the ability to use inhaled devices in patients with COPD correctly?","volume":"26","author":"Latorre","year":"2020","journal-title":"Pulmonology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.rmed.2007.11.003","article-title":"Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD","volume":"102","author":"Lavorini","year":"2008","journal-title":"Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1016\/j.rmed.2007.06.008","article-title":"Can all patients with COPD use the correct inhalation flow with all inhalers and does training help?","volume":"101","author":"Tarsin","year":"2007","journal-title":"Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106724","DOI":"10.1016\/j.rmed.2021.106724","article-title":"Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literature","volume":"191","author":"Monteiro","year":"2022","journal-title":"Respir. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12931-024-03084-7","article-title":"Comparative analysis of real-world data on the efficacy and safety of and adherence to ICS\/LABA combinations in asthma management","volume":"26","author":"Park","year":"2025","journal-title":"Respir. Res."},{"key":"ref_17","first-page":"94","article-title":"Comparison of the Adherence to Metered Dose Inhalers Versus Dry Powder Inhalers in Patients with Newly Diagnosed Chronic Obstructive Pulmonary Disease","volume":"8","author":"Zaib","year":"2018","journal-title":"J. Saidu Med. Coll."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4104\/pcrj.2011.00022","article-title":"Inhaler device, administration technique, and adherence to inhaled corticosteroids in patients with asthma","volume":"20","author":"Roy","year":"2011","journal-title":"Prim. Care Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1038\/s41533-024-00391-w","article-title":"Asthma prescribing trends, inhaler adherence and outcomes: A Real-World Data analysis of a multi-ethnic Asian Asthma population","volume":"34","author":"Toh","year":"2024","journal-title":"Npj Prim. Care Respir. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1080\/02770903.2022.2144355","article-title":"Evaluation of real-life data on the use of inhaler devices, including satisfaction and adherence to treatment, by community pharmacists in partnership with pulmonary disease specialists","volume":"60","author":"Gemicioglu","year":"2023","journal-title":"J. Asthma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4168\/aair.2020.12.3.454","article-title":"Efficacy and safety of a pressurized metered-dose inhaler in older asthmatics: Comparison to a dry powder inhaler in a 12-week randomized trial","volume":"12","author":"Woo","year":"2020","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_22","first-page":"2335","article-title":"The importance of inhaler devices: The choice of inhaler device may lead to suboptimal adherence in COPD patients","volume":"10","author":"Sicras","year":"2015","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1016\/j.jaip.2023.03.053","article-title":"Is Once Versus Twice Daily Dosing Better for Adherence in Asthma and Chronic Obstructive Pulmonary Disease?","volume":"11","author":"Vuong","year":"2023","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/02770903.2019.1663429","article-title":"Medication adherence in patients with asthma using once-daily versus twice-daily ICS\/LABAs","volume":"58","author":"Averell","year":"2021","journal-title":"J. Asthma"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1016\/j.jaip.2018.12.021","article-title":"Assessment of Adherence and Asthma Medication Ratio for a Once-Daily and Twice-Daily Inhaled Corticosteroid\/Long-Acting \u03b2-Agonist for Asthma","volume":"7","author":"Stanford","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1007\/s12325-024-03055-w","article-title":"Adherence and Persistence with Single-Inhaler Triple Therapy Among Patients with COPD Using Commercial and Medicare Advantage US Health Plan Claims Data","volume":"42","author":"Young","year":"2024","journal-title":"Adv. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Price, D., Robertson, A., Bullen, K., Rand, C., Horne, R., and Staudinger, H. (2010). Improved adherence with once-daily versus twice-daily dosing of mometasone furoate administered via a dry powder inhaler: A randomized open-label study. BMC Pulm. Med., 10.","DOI":"10.1186\/1471-2466-10-1"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Murillo, E.R., Mora, J.R.M., Bachiller, M.M., Santiago, L.G., Braqu\u00e9, N.N., and Bravo, M.O. (2025). Factors associated with low adherence to inhaled therapy in patients with chronic respiratory diseases: A cross-sectional study. BMC Pulm. Med., 25.","DOI":"10.1186\/s12890-025-03563-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1738","DOI":"10.4187\/respcare.07355","article-title":"Barriers and Strategies for Improving Medication Adherence Among People Living With COPD: A Systematic Review","volume":"65","author":"Bhattarai","year":"2020","journal-title":"Respir. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.jaip.2019.02.023","article-title":"ELLIPTA Dry Powder Versus Metered-Dose Inhalers in an Optimized Clinical Trial Setting","volume":"7","author":"Kerwin","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1111\/j.1742-1241.2007.01574.x","article-title":"Therapeutic comparison of a new budesonide\/formoterol pMDI with budesonide pMDI and budesonide\/formoterol DPI in asthma","volume":"61","author":"Morice","year":"2007","journal-title":"Int. J. Clin. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1517\/17425247.2016.1130695","article-title":"The influence of type of inhalation device on adherence of COPD patients to inhaled medication","volume":"13","author":"Movig","year":"2016","journal-title":"Expert. Opin. Drug. Deliv."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.2147\/COPD.S431829","article-title":"Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment","volume":"18","year":"2023","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rmed.2019.01.019","article-title":"Assessment of COPD-related outcomes in patients initiating a once daily or twice daily ICS\/LABA","volume":"150","author":"Stanford","year":"2019","journal-title":"Respir. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.2147\/COPD.S460903","article-title":"Evaluation of Adherence and Persistence to Triple Therapy in Patients with COPD: A German Claims Data Study","volume":"19","author":"Vogelmeier","year":"2024","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Alshabanat, A., Zafari, Z., Albanyan, O., Dairi, M., and FitzGerald, J.M. (2015). Asthma and COPD Overlap Syndrome (ACOS): A Systematic Review and Meta Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0136065"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e000823","DOI":"10.1136\/bmjresp-2020-000823","article-title":"Determinants of poor inhaler technique and poor therapy adherence in obstructive lung diseases: A cross-sectional study in community pharmacies","volume":"8","author":"Vanoverschelde","year":"2021","journal-title":"BMJ Open Respir. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"463","DOI":"10.37765\/ajmc.2021.88773","article-title":"Initial maintenance therapy adherence among older adults with asthma-COPD overlap","volume":"27","author":"Nili","year":"2021","journal-title":"Am. J. Manag. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"117733","DOI":"10.1016\/j.jclepro.2019.117733","article-title":"Life cycle environmental impacts of inhalers","volume":"237","author":"Jeswani","year":"2019","journal-title":"J. Clean. Prod."}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/5\/44\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T08:05:39Z","timestamp":1760515539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/5\/44"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,11]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["arm93050044"],"URL":"https:\/\/doi.org\/10.3390\/arm93050044","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,11]]}}}