Pediatric Prescribing of Asthma Drugs in the UK: Are We Sticking to the Guideline?

Abstract

Cohen S, Taitz J, Jaffé A. Arch Dis Child. 2007;92(10):847–849 PURPOSE OF THE STUDY. Similar to those in the United States, there are asthma-treatment guidelines in the United Kingdom, which were published in 1993 and updated in 1995, 1997, 2003, and 2005. The authors wondered whether the prescribing habits of physicians reflect recommendations in these guidelines. STUDY POPULATION. The population studies was persons in the United Kingdom National Health Service Information database, which includes all prescriptions dispensed by community pharmacists and dispensing doctors. METHODS. Prescriptions for children were reviewed for the years 2000–2006. RESULTS. From 2000 to 2006, the number of prescriptions for bronchodilator syrups decreased 60% from 302 500 to 121 000. The use of steroid-alone inhalers declined 22% from 1 968 000 to 1 525 000, whereas the use of combination steroid/long-acting β-agonist (LABA) inhalers increased sevenfold from 50 000 to 350 000. The percentage of total steroid inhalers prescribed as combination inhalers increased from 2% to 20%. CONCLUSIONS. The authors concluded that the increase in the number of combination inhalers prescribed is not consistent with the guideline recommendations that combination inhalers should only be introduced in those patients with asthma that is not controlled on adequate doses of inhaled steroids. REVIEWER COMMENTS. The authors noted that inhaled bronchodilators have fewer adverse effects and that, although the use of the oral bronchodilators has declined, there are still a large number of prescriptions being written for them. On the basis of other studies, they estimated that only 5% to 10% of children with asthma would qualify for treatment with combined inhaled-steroid/LABA inhalers, yet 20% are prescribed such medications. I suspect that these findings would be the same in the United States. It is useful to reinforce that that there is virtually no indication for treatment with oral bronchodilators, and only children whose condition has failed to respond to treatment with low- to medium-dose inhaled steroids alone should be treated with inhaled-steroid/LABA combinations.