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(07/17/2025) VA Center for Clinical Management Research investigators identified a 5% increase in all-cause emergency department visits, an 8% increase in all-cause hospitalizations, a 10% increase in respiratory-related hospitalizations, and a 24% increase in pneumonia-specific hospitalizations among Veterans with chronic obstructive pulmonary disease (COPD) and asthma, following a switch from metered-dose inhalers to dry-powder inhalers. There was no change in the number of patient deaths. In 2021, VA made the switch between the two inhalers based on cost analysis and environmental benefits. The researchers examined the health records of nearly 260,000 Veterans prescribed an inhaler for COPD or asthma from January 2018 to December 2022. They found that the increased adverse outcomes were associated with three elements: the medication change itself, the device and delivery of the medication, and other factors such as disruptions in treatment routines and difficulties in implementation. The findings suggest a need to re-evaluate the type of inhaler medication prescribed in VA. (JAMA Internal Medicine, Jul. 7, 2025)