AB013. Inappropriate asthma therapy: a tale of two countries
Anjan Nibber1, Manon Belhassen2,3, Eric Van Ganse2, Dermot Ryan4,5, Carole Langlois2,3, Francis Appiagyei5, Derek Skinner5, Laurent Laforest2,3, Joan B. Soriano1,6, David Price1,7
Background: Inappropriate prescribing and misuse of asthma medication, have been identified as potentially preventable factors linked to asthma exacerbations and deaths. A recent report by the National Review of Asthma Deaths drew attention to the excessive prescribing of reliever medication, and under-prescribing of controlled medication in the United-Kingdom (UK). The inappropriate prescribing of long-acting beta agonist (LABA) bronchodilator inhalers, as either a monotherapy or without inhaled corticosteroids (ICS) has been highlighted as a major preventable factor of asthma exacerbations and deaths. To determine whether the prevalence of inappropriate LABA therapy use in asthma in the UK and in France has changed over time.
Methods: Two interval, parallel, population-based cohorts (2007 and 2013), were developed in each country, utilising the UK Optimum Patient Care Research Database and the French Permanent Beneficiaries Sample database. Following inclusion, patients aged 6–40 years were studied over a 12-month period. The use of LABAs without ICS, and ≥2-fold higher use of LABA compared with ICS were investigated. Analyses were stratified by age groups: children (6–13 years) and adults (14–40 years).
Results: Overall, 39,743 UK and 4,910 French patients were included in 2007 and 14,036 and 5,657 in 2013. In 2013, LABA use without ICS occurred in 0.1% and 1.5% of UK and French adults respectively. This was a marked reduction from 2007 UK and French figures of 0.4% and 2.6% respectively (P<0.05 for both). Excessive use of LABA relative to ICS occurred in 0.2% of UK adults and in 0.7% of French adults in 2013. These percentages represented a decrease from the 2007 figures of 0.6% and 1.4% for UK (P=0.29) and France (P=0.003), respectively. In 2007, LABA inappropriate use was more frequent in French than UK asthmatic children (P<0.0001), but showed a downward trend by time in both countries (0.1% in 2013 in both countries).
Conclusions: Our study suggests that despite noticeable differences in the healthcare systems between these two countries, there has been a marked reduction of inappropriate LABA use in asthma in recent years. Despite this, 7,480 and 55,650 patients with asthma in the UK and France respectively, were inappropriately prescribed LABAs, highlighting the necessity of corrective measures to reduce the asthma-associated burden.
Keywords: Asthma therapy; long-acting beta agonist (LABA); inappropriate prescribe
doi: 10.21037/jtd.2016.s013
