Behind the Headlines

Wednesday September 5 2007

Picture of a child with an inhaler

Are combination inhalers overprescribed?

GPs in the UK are prescribing the wrong asthma medication to children, said The Daily Telegraph. The newspaper said that “at least 100,000 patients aged under 16 are prescribed inhalers containing long-acting beta agonists and steroids when they should be able to control symptoms with milder inhalers” and that “a further 121,000 are taking bronchodilator syrups which are less effective”. It said that UK prescriptions for asthma go against current guidance.

The newspaper reports are based on research data collected on prescriptions for children with asthma in the UK from 2000 to 2006. Although this study can identify trends in asthma medication prescribing, it is not able to give detailed information about prescribing practice and it cannot show whether these prescriptions were appropriate in light of current guidance.

Where did the story come from?

Simon Cohen and colleagues of Sydney Children’s Hospital, New South Wales, Australia, conducted this research. The authors report that no funding was received for the study and it was published in the peer-reviewed medical journal, Archives of Disease in Childhood.

What kind of scientific study was this?

This was a time trend study designed to assess prescription patterns for childhood asthma in the UK from 2000 to 2006, and to see how this has been affected by the British Thoracic Society (BTS) guideline that was updated in 2005.

The researchers obtained information from the NHS about asthma medication prescriptions made by GPs in England for the period. They calculated the total number of prescriptions of combined inhalers and bronchodilator syrups made in each year.

What were the results of the study?

The researchers found that the total number of prescriptions made for bronchodilator syrup in 2006 was 121,000. This represented a fall of 60% in prescribing between 2000 and 2006. There was also a reduction in the prescription of steroid-only inhalers, while there was an increase in the number of combination inhalers, containing long-acting beta agonists and steroids, prescribed. The use of long-acting beta agonists doubled over the six-year period.

What interpretations did the researchers draw from these results?

There are good simple treatment protocols which should be followed more often.

Sir Muir Gray

The researchers conclude that prescriptions of combination inhaler have increased in the UK. They say that this is not in line with current British Thoracic Society guidance, which suggests that long-acting beta agonists (used as “add on therapy” when other medications are insufficient to control symptoms) should only be prescribed to those over the age of 5, and only when the maximum dose of inhaled steroid has been tried first. Bronchodilator syrup prescriptions have decreased, but use is still quite high, even though British Thoracic Society guidance suggests inhalers are preferable. The researchers emphasise that steroid-only inhalers should be considered as first-line treatment, and highlight the need for “further education of health professionals”.

What does the NHS Knowledge Service make of this study?

When interpreting this research the following points should be considered:

  • It cannot be assumed that GPs are going against current guidance. For example, it is not known whether GPs had already tried the maximum dose of inhaled steroid for each child before prescribing combination inhalers, as recommended.
  • The ages of the individuals that certain drugs were prescribed for is not known; therefore, for example, it cannot be said whether long-acting bronchodilators are being prescribed to children of an inappropriately young age.
  • Although the newspapers have highlighted the use of “less effective syrups”, this study has demonstrated their use to be declining.

Sir Muir Gray adds...

This is a very serious issue. There are good simple treatment protocols which should be followed more often; the NHS needs to decide what to do with this new information. 

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

GPs snub child asthma advice. BBC News, September 3 2007

Quarter of children with asthma ‘on wrong medication'. The Daily Telegraph, September 4 2007

Links to the science

Cohen SA, Taitz J, Jaffe A. Paediatric prescribing of asthma drugs in the UK: are we sticking to the guidelines? Arch Dis Child 2007; Sep 4 [Epub ahead of print]

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