I feel they are very appropriate to simplify regimes and improve compliance for many patients and if selected based on the correct criteria -are excellent. I have concerns that as a patient stabilises post exacerbation etc that it will be increasingly difficult to step these patients down of the steroid dose to LABA/LAMA. The dosage of steroid within these devices being fixed raises issues for me also.
I worry that patients may take more than the recommended dose especially the once-daily option when they are having acute symptoms. I have experienced this first hand with one of my patients.
Compliance with treatment plans is the backbone of improving symptoms and reducing risk, so on this basis anything that assists this should be carefully considered. They clearly target classic GOLD Category D patients in COPD and with correct assessment based on CAT, mMRC, exacerbation history and/or spirometry results they play a key role in the management of these patients.
There is a need to ensure that each patient can correctly use these devices as ‘all eggs are being put into one therapy basket’.