Key factors for implementing inhaler regimen switches in respiratory diseases: international expert consensus generated using a modified nominal group technique (NGT)

Why changing inhalers matters to everyday breathing

For millions of people living with asthma or chronic obstructive pulmonary disease (COPD), inhalers are a daily lifeline. Yet the specific device or medicine they use can be switched for many reasons, from poor symptom control to supply shortages or cost pressures. This article explores when changing an inhaler is truly in a patient’s best interests, and when it may do more harm than good. An international panel of experts set out clear, practical rules to guide safe inhaler changes and highlight the time and care needed to do them well.

How the experts reached common ground

Because high-quality studies on inhaler switching are limited, the researchers gathered structured opinions from eight specialists in respiratory medicine, nursing, pharmacy, health economics, and patient advocacy across six countries. Using a method called the nominal group technique, the panelists first generated ideas independently in response to four questions: when switches are appropriate, when they are not, what steps a good switch requires, and who should be involved. They then discussed, merged overlapping ideas, and anonymously rated the importance of each statement. This process produced 80 agreed “quality statements” that form a practical framework for real-world care.

When an inhaler change can be the right move

The experts agreed that the strongest reasons to switch an inhaler are firmly rooted in a person’s health and day-to-day experience. Top priorities included poor disease control—such as ongoing symptoms or frequent flare-ups—and clear problems with using the current device, for example because of arthritis, weak breathing strength, or memory and attention difficulties. Other good reasons were simplifying complex regimens, changing to a treatment that can both prevent and relieve attacks, adding a spacer to improve delivery, and addressing dissatisfaction with the inhaler. Operational issues like manufacturer shortages or a patient’s own financial strain were seen as valid but secondary triggers, to be weighed only after clinical needs and patient preferences are addressed.

When switching is unsafe or unfair

The panel was especially clear about situations where switching is inappropriate. Changing an inhaler without talking to the patient or caregiver, without their consent, or without proper training and follow-up was unanimously judged unsafe. Swapping devices in patients whose condition is stable, introducing more complicated regimens, or ignoring physical or cognitive limits that might make a new device hard to use were also seen as high-risk. By contrast, policy goals such as cutting costs or lowering the carbon footprint of inhalers were rated as weak reasons for switching on their own. The message is that protecting the patient’s safety, confidence, and ability to use the device correctly must come first; environmental and economic considerations can be layered on only after those basics are secured.

What a careful inhaler change actually involves

Beyond deciding whether to switch, the experts mapped out what a thorough switch visit should look like. They described 28 essential activities and grouped them into a checklist: spotting the need for a change; assessing symptoms, flare-ups, breathing strength, and hand–device coordination; understanding the patient’s preferences and affordability; jointly choosing a new inhaler; teaching and checking inhaler technique with demonstration and “teach-back”; documenting the change; and planning future review. Every step was rated very to extremely important. Taken together, these tasks were estimated to require a median of 36 minutes per patient—more than three times a typical 10-minute primary care appointment—highlighting how resource-intensive it is to switch safely at scale.

Who needs to be at the table

The panel also examined who plays which role in inhaler decisions. Patients and caregivers were central, not only as users but as key initiators and influencers of change. Specialists, general practitioners, and respiratory nurses were all seen as major initiators and often the final decision-makers, depending on the health system. Pharmacists emerged as crucial gatekeepers who control access to particular devices and can influence choices through their expertise. Payers and regulators largely shape which inhalers are available and funded, while medical societies and patient groups influence practice through guidance and advocacy. Rather than a single decision-maker, inhaler switching is a shared journey in which skills, communication, and context matter more than job titles.

What this means for people with asthma and COPD

For patients and families, the core conclusion is reassuring: any change to an inhaler should start with your health and your voice, not with budgets or broad environmental targets. Switching can help when symptoms remain uncontrolled or the current device is hard to use, but it should never be done silently or rushed through. Safe switching requires time for careful assessment, explanation, hands-on training, and planned follow-up. Policymakers and health services, the authors argue, must recognise this workload if they wish to promote large-scale changes in inhaler use. Done properly, inhaler switches can support better breathing, fewer flare-ups, and more sustainable care; done poorly, they risk undermining control of already burdensome lung diseases.

Citation: Usmani, O.S., Roche, N., van Boven, J.F.M. et al. Key factors for implementing inhaler regimen switches in respiratory diseases: international expert consensus generated using a modified nominal group technique (NGT). npj Prim. Care Respir. Med. 36, 22 (2026). https://doi.org/10.1038/s41533-026-00489-3

Keywords: asthma inhalers, COPD treatment, inhaler switching, patient-centred care, respiratory guidelines