Β2-Agonists: consensus guidelines not followed in asthma

PharmacoEconomics & Outcomes News 319 - 30 Jun 2001 β 2 -Agonists: consensus guidelines not followed in asthma When compared to the recommendations of the 1996 Canadian Asthma Consensus Conference, inhaled short- acting β 2 -agonists (ISABAs) are overused, inhaled corticosteroids (ICS) are underused, and inhaled long- acting β 2 -agonists (ILABAs) are often used inappropriately, according to the findings of a study carried out by investigators in the Canadian province of Qu´ ebec. The investigators retrospectively analysed pharmacist billing data * related to outpatients with asthma who received ≥ 1 prescription for ISABA or ILABA therapy during 1997–1998, and the appropriateness of the patients’ medication use when compared to the Canadian consensus guidelines. Overuse, underuse, improper use The investigators found that among 33 416 outpatients (aged 5–45 years) receiving ISABA therapy, the proportion of appropriate use was 75% in patients not concurrently receiving ICS therapy, 84% among patients with 1 ICS prescription, and 43% among patients with ≥ 2 ICS prescriptions; overall appropriateness was higher in younger patients (aged 5–11 years) and in those who were treated by a paediatrician, they say. Among the subgroup of 775 outpatients (aged 12–45 years) receiving ILABA therapy, criteria for appropriate use – defined as the correct interval for refilling a prescription and the necessity of using a corticosteroid concurrently – were met in 19 and 15% of patients, respectively. Appropriate use was higher among patients who were treated by a respirologist, note the investigators. Several reasons for suboptimal use The investigators suggest that suboptimal medication use in this cohort may be due to several factors, including: • differences in training and practice volume between specialists and general practitioners • patients may use medications that provide immediate relief in preference to medications that treat the underlying cause • copayments by users may reduce compliance. The investigators recommend that ‘since the use of drugs is the outcome of a process involving mainly the physician, the pharmacist, and the patient, behavioral changes should be sought in all three to improve the pharmacotherapy of asthma’. * Prescription Drug Insurance Plan data from the Qu´ ebec Health Insurance Board Blais R, et al. Ambulatory use of inhaled beta-2-agonists for the treatment of asthma in Quebec: a population-based utilization review. Chest 119: 1316-1321, May 2001 800867757 1 PharmacoEconomics & Outcomes News 30 Jun 2001 No. 319 1173-5503/10/0319-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Transcript of Β2-Agonists: consensus guidelines not followed in asthma

PharmacoEconomics & Outcomes News 319 - 30 Jun 2001

β2-Agonists: consensus guidelinesnot followed in asthma

When compared to the recommendations of the 1996Canadian Asthma Consensus Conference, inhaled short-acting β2-agonists (ISABAs) are overused, inhaledcorticosteroids (ICS) are underused, and inhaled long-acting β2-agonists (ILABAs) are often usedinappropriately, according to the findings of a studycarried out by investigators in the Canadian province ofQuebec.

The investigators retrospectively analysed pharmacistbilling data* related to outpatients with asthma whoreceived ≥ 1 prescription for ISABA or ILABA therapyduring 1997–1998, and the appropriateness of thepatients’ medication use when compared to theCanadian consensus guidelines.

Overuse, underuse, improper useThe investigators found that among 33 416

outpatients (aged 5–45 years) receiving ISABA therapy,the proportion of appropriate use was 75% in patientsnot concurrently receiving ICS therapy, 84% amongpatients with 1 ICS prescription, and 43% amongpatients with ≥ 2 ICS prescriptions; overallappropriateness was higher in younger patients (aged5–11 years) and in those who were treated by apaediatrician, they say. Among the subgroup of 775outpatients (aged 12–45 years) receiving ILABA therapy,criteria for appropriate use – defined as the correctinterval for refilling a prescription and the necessity ofusing a corticosteroid concurrently – were met in 19 and15% of patients, respectively. Appropriate use washigher among patients who were treated by arespirologist, note the investigators.

Several reasons for suboptimal useThe investigators suggest that suboptimal medication

use in this cohort may be due to several factors,including:• differences in training and practice volume between

specialists and general practitioners• patients may use medications that provide

immediate relief in preference to medications thattreat the underlying cause

• copayments by users may reduce compliance.The investigators recommend that ‘since the use of

drugs is the outcome of a process involving mainly thephysician, the pharmacist, and the patient, behavioralchanges should be sought in all three to improve thepharmacotherapy of asthma’.* Prescription Drug Insurance Plan data from the Quebec HealthInsurance Board

Blais R, et al. Ambulatory use of inhaled beta-2-agonists for the treatment ofasthma in Quebec: a population-based utilization review. Chest 119: 1316-1321,May 2001 800867757