Abstract
ObjectiveTo estimate the level of dispensing of oral corticosteroids (OCS) for managing asthma in Australia, with a particular focus on the cumulative dispensing of doses associated with long term toxicity (≥ 1000 mg prednisolone‐equivalent).DesignRetrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data.Participants, settingPeople aged 12 years or more treated for asthma during 2014–2018, according to dispensing of controller inhaled corticosteroids (ICS).Main outcome measuresNumber of people dispensed OCS for managing asthma during 2014–2018; proportion who were cumulatively dispensed at least 1000 mg prednisolone‐equivalent. The secondary outcome was the number of people dispensed at least 1000 mg prednisolone‐equivalent during 2018, stratified by inhaler controller dose and use.Results124 011 people had been dispensed at least two prescriptions of ICS during 2014–2018 and met the study definition for asthma, of whom 64 112 (51.7%) had also been dispensed OCS, including 34 580 (27.9% of the asthma group) cumulatively dispensed 1000 mg prednisolone‐equivalent or more. Of 138 073 people dispensed OCS at this level, 68 077 (49%) were patients with airway diseases. Dispensing of diabetes and osteoporosis medications was more common for people cumulatively dispensed 1000 mg prednisolone‐equivalent or more. During 2018, 4633 people with asthma using high dose ICS controllers were dispensed 1000 mg prednisolone‐equivalent or more, for 2316 of whom (50%) controller use was inadequate.ConclusionsCumulative exposure to OCS in Australia reaches levels associated with toxicity in one‐quarter of patients with asthma using ICS. Cumulative dispensing of potentially toxic OCS amounts often accompanies inadequate inhaler controller dispensing. Better approaches are needed to improve adherence to controller therapy, improve outcomes for people with asthma, and to minimise the use and toxicity of OCS.
Highlights
Participants, setting: People aged 12 years or more treated for asthma during 2014–2018, according to dispensing of controller inhaled corticosteroids (ICS)
Cumulative exposure to oral corticosteroids (OCS) in Australia reaches levels associated with toxicity in one-quarter of patients with asthma using ICS
To understand the magnitude of the risk associated with OCS, we analysed Australian reciprocal health care agreements with Australia.[8]
Summary
The Australian Pharmaceutical Benefits Scheme (PBS) is a national program that subsidises medication costs for citizens and permanent residents, and for people from countries with. The primary objective was to estimate the number and proportion of people dispensed OCS for managing asthma during 2014–2018, and the proportion dispensed a cumulative dose of 1000 mg prednisolone-equivalent or more over the 5-year period. 8 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW. Research number and proportion of patients dispensed a cumulative dose of 1000 mg prednisolone-equivalent or more during 2018 (ie, over 12 months), stratified by inhaler controller medication use University of Sydney, Sydney, NSW. 6 Rural Clinical School, Australian National University, Canberra, ACT. 7 Concord Hospital, Sydney, NSW. 8 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW. 9 University of Queensland, Brisbane, QLD.
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