Background In 2014, the Royal College of Physicians published the National Review of Asthma Deaths. This confidential enquiry into 195 confirmed asthma deaths in the UK highlighted that two thirds of these deaths were associated with potentially modifiable prescription factors including excessive short-acting beta agonist (SABA) use without review and prescription of long acting beta agonists (LABA) without inhaled corticosteroids (ICS), the latter of which have been associated with higher mortality.1
Aim The aim of this project was to determine how widespread these two modifiable prescription factors are in the treatment of asthma in UK general practice.
Methods Primary Care data were obtained from the Optimum Patient Care Research Database (OPCRD). Extraction criteria included patients with a current diagnosis of asthma, at least two years of continuous medical records and at least one asthma prescription in the preceding 12 months. Those who: had a comorbid diagnosis of COPD, had received no treatment for the past 12 months and children <4 years of age were excluded. Asthma prescription data for the previous 12 months were extracted, and patients who had been prescribed LABAs with no ICS, or who had been prescribed ≥12 SABA inhalers without an asthma review (as coded by QOF) were identified.
Results 94,955 asthma patients met the inclusion criteria, of which 12661 (13%) were children. LABAs with no ICS had been prescribed to 402 patients (0.4%). A total of 5032 patients (5.3%) had been prescribed ≥ 12 SABA inhalers, ranging from 13–136 inhalers of which 1965 (39%) had not had an asthma review. Among these, 117 were children, 0.92% of the total.
Conclusion These data, covering a large GP population, suggest evidence of non-guideline recommended prescribing which might contribute to increased risk to asthma patients. Prescribers should consider implementing system alerts to identify and review such prescribing behaviours.
Reference 1 Lee C, Corren J. Budesonide/formoterol in the treatment of asthma. Expert Rev Respir Med 2008;2:551–64