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Homaira N, Daniels B, Pearson S, Jaffe A. Dispensing Practices of Fixed Dose Combination Controller Therapy for Asthma in Australian Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165645. [PMID: 32764390 PMCID: PMC7460523 DOI: 10.3390/ijerph17165645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022]
Abstract
The Australian Asthma Handbook does not recommend use of fixed dose combination (FDC) controller medicines for asthma in children aged ≤5 years. FDCs are only recommended in children and adolescents (aged 6-18 years) not responding to initial inhaled corticosteroid (ICS) therapy. Using Pharmaceutical Benefits Scheme dispensing claims from 2013-2018, we examined the annual incident FDC dispensing and the incident FDC dispensing without prior ICS up to 365 days. We also determined cost of FDCs to government and patients. During 2013-2018, there were 35,635 FDC initiations and 31,368 (88%) did not have a preceding ICS dispensing. The annual incidence of FDC dispensing declined from 14.7 to 7.2/1000 children. Incidence of FDC dispensing/1000 children without a preceding ICS declined from 2.1 to 0.5 in children aged 1-2 years, 7.2 to 1.7 in 3-5 years, 14.8 to 5.1 in 6-11 years, and 18.6 to 11.9 in ≥12years. The cost of FDCs was 7.8 million Australian dollars (AUD); of which 4.4 million AUD was to government and 3.3 million AUD was to patient. Despite inappropriate dispensing of FDCs in children aged ≤5 years, incidence of FDC dispensing and more importantly incidence without a preceding ICS is declining in Australia.
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Affiliation(s)
- Nusrat Homaira
- Discipline of Paediatrics, School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Sydney 2052, Australia;
- Respiratory Department, Sydney Children’s Hospital, Sydney 2031, Australia
- Correspondence:
| | - Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Sydney 2052, Australia; (B.D.); (S.P.)
| | - Sallie Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, Sydney 2052, Australia; (B.D.); (S.P.)
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Sydney 2052, Australia;
- Respiratory Department, Sydney Children’s Hospital, Sydney 2031, Australia
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Sly PD. Predicting which children have asthma: Are we any closer to finding the Holy Grail? Respirology 2019; 24:510-511. [PMID: 30884024 DOI: 10.1111/resp.13529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Peter D Sly
- Children's Health and Environment Program, The University of Queensland, Brisbane, QLD, Australia
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Casares-Alonso I, Cano-Garcinuño A, Blanco-Quirós A, Pérez-García I. Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Casares-Alonso I, Cano-Garcinuño A, Blanco-Quirós A, Pérez-García I. Anti-asthmatic prescription variability in children according to age. Allergol Immunopathol (Madr) 2015; 43:383-91. [PMID: 25444114 DOI: 10.1016/j.aller.2014.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/09/2014] [Accepted: 05/25/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is little research in the Spanish paediatric population about the consumption of anti-asthmatic agents. The aim of this study was to describe the current pattern of anti-asthmatic drug prescription in the paediatric population from a region of Spain, using the prescribed daily dose as a unit of measurement. METHODS We analysed the requirements of R03 therapeutic subgroup (anti-asthmatic agents) in children less than 14 years of age in the Public Health System of Castilla y León from 2005 to 2010. Consumption data are presented in prescribed daily doses per thousand inhabitants per day (PDHD) and compared with defined daily doses per thousand inhabitants per day (DHD). RESULTS 394 876 prescriptions of anti-asthmatics were given to a population of 1 580 229 persons/year. Bronchodilators, leukotriene receptor antagonists, single inhaled corticosteroids (ICS) and long-acting β2-adrenergics associated with inhaled corticosteroids were the most commonly prescribed drugs: 7.5, 5.2, 4.9 and 2.2 PDHD, respectively. The maximum prescription of bronchodilators (15.9 PDHD/9.8 DHD) occurred in children under 12 months, with montelukast (8.9 PDHD/3.6 DHD) and single inhaled corticosteroids (7.9 PDHD/2.9 DHD) at one year of age. CONCLUSIONS Between 2005 and 2010, children under four years received a high prescription of anti-asthmatic drugs. The use of maintenance therapy was poorly aligned with the recommendations of asthma guidelines. The PDHD was more accurate for measuring consumption than DHD, especially in younger children.
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Affiliation(s)
- I Casares-Alonso
- Venta de Baños Health Centre, Regional Health Service, Castilla y León, Palencia, Spain.
| | - A Cano-Garcinuño
- Villamuriel de Cerrato Health Centre, Regional Health Service, Castilla y León, Palencia, Spain
| | | | - I Pérez-García
- Jardinillos Health Centre, Regional Health Service, Castilla y León, Palencia, Spain
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Casares Alonso I, Cano Garcinuño A, Blanco Quirós A, Pérez García I. [Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability]. An Pediatr (Barc) 2014; 83:191-200. [PMID: 26363566 DOI: 10.1016/j.anpedi.2014.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/18/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution. MATERIAL AND METHODS An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study. RESULTS A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low. CONCLUSIONS The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment.
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Affiliation(s)
- I Casares Alonso
- Centro de Salud de Venta de Baños, Venta de Baños, Palencia, España.
| | - A Cano Garcinuño
- Centro de Salud Villamuriel de Cerrato, Villamuriel de Cerrato, Palencia, España
| | - A Blanco Quirós
- Facultad de Medicina, Universidad de Valladolid, Valladolid, España
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Astle V, Broom M, Todd DA, Charles B, Ringland C, Ciszek K, Shadbolt B. Respiratory outcomes study (RESPOS) for preterm infants at primary school age. J Asthma 2014; 52:40-5. [PMID: 25162302 DOI: 10.3109/02770903.2014.952436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pulmonary function abnormalities and hospital re-admissions in survivors of neonatal lung disease remain highly prevalent. The respiratory outcomes study (RESPOS) aimed to investigate the respiratory and associated atopy outcomes in preterm infants <30 weeks gestational age (GA) and/or birth-weight (BWt) <1000 g at primary school age, and to compare these outcomes between infants with and without chronic lung disease (CLD). METHODS In the RESPOS 92 parents of preterm infants admitted to the Neonatal unit in Canberra Hospital between 1/1/2001 and 31/12/2003 were sent a questionnaire regarding their respiratory, atopy management and follow-up. RESULTS Fifty-three parents responded, including 28 preterm infants who had CLD and 25 who had no CLD. The gestational age was significantly lower in the CLD group compared to the non-CLD group [26.9 (26.3-27.5) CLD and 28.6 (28.3-29.0) non-CLD] [weeks [95% confidence interval (CI)]], as was the birth weight [973 (877.4-1068.8) CLD versus 1221 (1135.0-1307.0) non-CLD] [g (CI)]. CLD infants compared to non-CLD infants were significantly more likely to have been: given surfactant, ventilated and on oxygen at 28 days and 36 weeks. These neonates were also more likely to have: been discharged from the neonatal unit on oxygen, exhibit a history of PDA or sepsis and to have a current paediatrician. However, despite these differences, there was no significant difference in the proportion of asthma or atopic disease between the two groups. CONCLUSIONS The RESPOS could not demonstrate respiratory and/or atopy differences between the CLD and the non-CLD groups at primary school age.
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Affiliation(s)
- Valerie Astle
- Department of Neonatology , Centenary Hospital for Women and Children , Canberra , Australia
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Robinson PD, Van Asperen P. Update in paediatric asthma management: where is evidence challenging current practice? J Paediatr Child Health 2013; 49:346-52. [PMID: 21470328 DOI: 10.1111/j.1440-1754.2010.01975.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extrapolation of management strategies based on results from predominantly adult asthma studies frequently occurs in paediatric asthma despite increasing evidence that paediatric asthma and, in particular, pre-school recurrent wheeze are very different disease entities. Response to medications in paediatric subjects is often different from that seen in their older adolescent and adult counterparts. In this update, we discussed recent studies that have had important implications for future paediatric asthma management. The overuse of combination inhaled steroid and long-acting beta2 agonist inhalers in paediatric asthma despite ongoing safety concerns is an increasing trend in paediatric asthma, and recent evidence has helped clarify how they should be used in children. Other aspects discussed include the role of oral corticosteroids in pre-school viral-induced wheeze and the utility of leukotriene receptor antagonists in exercise-induced asthma.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, New South Wales, Australia.
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Abstract
Asthma is a prevalent health condition in children, with economic implications for the individual and their family, as well as for societies with nationalized healthcare. Pharmaceutical cost is the main driver of healthcare expenditure in asthma. Existent explicit guidelines are meant to guide asthma management across all age groups, but they are failing. Pharmacologic management of asthma consists of a stepwise treatment approach to achieve symptom control. Various studies suggest a significant number of medical practitioners are prescribing inhaled corticosteroids (ICS) and ICS/long-acting beta agonist (LABA) combination inhalers inappropriately, including prescribing high doses of ICS without specialist consultation. ICS/LABA combination inhalers should only be used in persistent asthmatics, which account for approximately 5% of all children with asthma. Despite this, there is an increase in prescribing rates of ICS/LABA combination inhalers in the context of a decrease in the prevalence of asthma. Furthermore, there is inappropriate prescribing of ICS/LABA combination inhalers in children under 5 years of age, and initiation of relatively more expensive ICS/LABA combination inhalers in patients who have not previously been prescribed ICS. There is evidence to suggest that cost is a significant barrier to asthma management, especially for the more expensive ICS/LABA combination inhalers. Hence, prescribing cost-effective asthma medications appropriately is one of the most important strategies in reducing the morbidity and mortality associated with asthma. It is incumbent on every medical practitioner to not prescribe expensive medications if not indicated, both for the sake of the patient and for society.
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Affiliation(s)
- Sandra Chuang
- Respiratory Department, Sydney Childrens Hospital, Randwick, Sydney, NSW, Australia.
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Koster ES, Wijga AH, Zuidgeest MGP, Belitser SV, Raaijmakers JAM, Koppelman GH, Postma DS, Brunekreef B, de Jongste JC, Maitland-van der Zee AH. Patterns of asthma medication use: early asthma therapy initiation and asthma outcomes at age 8. Pharmacoepidemiol Drug Saf 2011; 19:991-9. [PMID: 20712022 DOI: 10.1002/pds.1961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Wheeze has many underlying pathophysiologies in childhood, but is the main reason for anti-asthma drugs prescription. This study was conducted to describe asthma medication use patterns among children in their first eight years of life. Longitudinal medication use data from 777 children participating in the PIAMA study were used. Medication patterns were described for four groups that started therapy before the third birthday, when the peak in prescriptions occurred in our cohort; short-acting β-agonists (SABA), inhaled corticosteroids (ICS), SABA + ICS or none of these. One third (n = 255) of the children received a first SABA or ICS prescription before age 8. Only three children (1.2%) used medication continuously during follow-up. Of the children who started SABA, 53.8% discontinued within 1-2 years. Of the children who started ICS before age 3, 42.1% discontinued within 1-2 years and 31.6% received additional SABA. 41.5% of the children who started SABA + ICS used this short-term (≤1 -2 years) and 21.5% long-term (≥ 3 years). Fifteen percent of children who did not start asthma therapy in their first 3 years of life did receive prescriptions between age 3 and 8. Children prescribed SABA + ICS before age 3 had the highest prevalence of hyper responsiveness at age 8, and similar prevalence of atopy as the other groups. Asthma medication is prescribed frequently in the first 8 years of life, particularly before age 3, and only few children use it continuously. ICS and SABA prescription occurs especially in those who were more likely to develop signs of asthma at age 8.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Uijen JHJM, van der Wouden JC, Schellevis FG, Willemsen SP, van Suijlekom-Smit LW, Bindels PJE. Asthma prescription patterns for children: can GPs do better? Eur J Gen Pract 2010; 17:109-15. [PMID: 21190392 DOI: 10.3109/13814788.2010.544299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Assessing prescription patterns of asthma medication for children is helpful to optimize prescribing by general practitioners (GPs). The aim was to explore prescription patterns in children with physician-diagnosed asthma and its determinants in general practice. METHODS We used the Second Dutch National Survey of General Practice (DNSGP-2) with children aged 0-17 years registered in 87 general practices. All children with at least one asthma prescription were included (n = 2993). Prescription rates and prescription of continuous (≥3 prescriptions/year) versus intermittent asthma medication were calculated. Data, including several GP characteristics, were analysed using multivariate logistic regression accounting for clustering within practices. RESULTS During one year, 16% of the children with physician-diagnosed asthma (n = 3562) received no asthma medication. Of the 2993 children with asthma receiving asthma medication (on average 2.9 prescriptions/year), 61% received one or two prescriptions, 39% received three or more. Continuous medication with a bronchodilator and/or a corticosteroid was prescribed in 22% of these children. One out of 5 children receiving continuous medication was prescribed a bronchodilator only. In 7.5% of the prescriptions, asthma medications other than bronchodilators or corticosteroids were prescribed. Prescribing asthma medication varied widely between practices, but none of the children and GP determinants had an independent effect on prescribing continuous versus intermittent medication. CONCLUSION In general practice, the annual number of asthma prescriptions per child with asthma is relatively low. One in 20 children is prescribed bronchodilators only continuously, indicating room for improvement. Child and GP characteristics cannot be used for targeting educational efforts.
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Affiliation(s)
- Johannes H J M Uijen
- Department of General Practice, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
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Bibliography. Current world literature. Model systems. Curr Opin Allergy Clin Immunol 2008; 8:276-85. [PMID: 18560306 DOI: 10.1097/aci.0b013e328303e104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW To review recent studies of changing medication use for asthma among children. RECENT FINDINGS Although many countries monitor mortality and hospitalizations related to asthma, there is less surveillance of medication use for asthma. Since the late 1990s, and in the United States, Australia and the United Kingdom, there has been a change in the medications used to prevent asthma in childhood, with an increase in inhaled corticosteroids, and a decrease in mast cell stabilizers. Prescriptions for montelukast have increased four-fold in the United Kingdom for children since 2000, with similar increases in the United States and in Australia. There has been a trend in some countries to increased use of fixed dose combined long-acting beta-agonist/inhaled corticosteroid products; in Australia and the United Kingdom, fixed dose combinations now account for the majority of preparations containing inhaled steroids prescribed to children with asthma. SUMMARY Studies in a number of countries have shown marked secular trends in asthma medications for children since the late 1990s. Research needs to employ serial cross-sectional studies in the same population to capture changing medication use and to be precise about types of medication within a class. The changes in many countries indicate a greater concordance with guidelines.
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Ponsonby AL, Glasgow N, Pezic A, Dwyer T, Ciszek K, Kljakovic M. A temporal decline in asthma but not eczema prevalence from 2000 to 2005 at school entry in the Australian Capital Territory with further consideration of country of birth. Int J Epidemiol 2008; 37:559-69. [PMID: 18276624 DOI: 10.1093/ije/dyn029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma prevalence has declined in some countries over the past 10 years. Most reports have been based on population surveys conducted at two points of time in a given location. Comparisons across countries and time periods can be limited by differences in study methodology or disease diagnostics in different communities. Here, we examined trends in asthma prevalence using serial annual data and further examine the importance of country of birth. METHODS The source population has children aged 4-6 commencing school in the Australian Capital Territory from 2000 to 2005 inclusive. Over 80% of these children and their families completed a health questionnaire on asthma, other atopic disease and respiratory symptoms using some questions from the International Study of Asthma and Allergies in Childhood (n = 22 882). Current asthma has been previously validated against physician assessment in this setting. RESULTS The prevalence of current asthma declined (P < 0.001) but eczema ever increased (P < 0.001) from 2000 to 2005. The asthma decline was predominantly linear in form, and accompanied by a reduction in night cough and shortness of breath but not recent wheeze. Compared with Australian-born children, children from New Zealand and the United Kingdom had a similar prevalence of asthma, hay fever and eczema history. However, children born in other countries, such as Asia, generally had a lower prevalence of these disorders. The temporal trends for atopic disorders or respiratory symptoms did not differ for overseas-born compared with Australian-born children. CONCLUSION The decline in current asthma prevalence from 2000 to 2005 was linear in form and appeared uncoupled from trends in child eczema. Country of birth was associated with marked variation in atopic disorder prevalence. The similar temporal trends for Australian vs overseas-born children indicate that the factors underlying the asthma prevalence decline are unlikely to be only in the pre-natal period.
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Affiliation(s)
- Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia
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