Background: Switching inhaler regimens for clinical or non-clinical reasons can incur variable consequences and damage patient?healthcare professional (HCP) relationships (Usmani, et al. JACI IP 2022;10:2624).

Objective: To develop a global expert consensus quality standard on how and when to implement appropriate inhaler regimen switches.

Method: A nominal group technique was used, comprising primary care, secondary care, payer and patient respiratory disease experts. Ideas were generated in response to research questions on appropriate switching, who should be involved and the best practice. Each response was independently rated or scored.

Results: Experts generated 80 ideas to the questions (excluding duplicate/overlapping ideas).

Error/s in inhaler technique, and inadequate disease control due to symptoms or exacerbations rated as ?very important? reasons for an inhaler regimen switch. No patient consultation and no training/ education rated as ?extremely important? reasons for preventing a switch.

Activities rated as ?considerably?, ?very? or ?extremely important? when implementing a switch and time required, are outlined in Figure 1. It was agreed that HCPs should initiate and implement switches.

Conclusion: Clinical and patient-led factors are the most important reasons for prompting or preventing an inhaler regimen switch. To implement an inhaler switch requires a median 35 minutes per patient.