Changes in primary care prescribing patterns for paediatric asthma: a prescribing database analysis

Elkout, Hajer; Helms, Peter Joseph Benedict; Simpson, Colin R; McLay, James S.

doi:10.1136/adc.2010.206268

Cited by 27 publications

(35 citation statements)

References 38 publications

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“…Similar to our results, there are several studies reporting SABA and ICS as most prevalent respiratory drugs used in children [7], [8], [17]. Nevertheless, there is some inter-country variation as reported by Bianchi et al [7].…”

Section: Discussionsupporting

confidence: 92%

“…Whereas Elkout et al reported the fraction of patients aged less than 19 years of age treated with a particular drug class [17], Baiardi et al presented the number of prescriptions for eleven compounds representing 90% of R03 (according to ATC) prescriptions given to children aged between 0 and 14 years of age [1]. Despite these methodological differences compared to our study reporting PPR, some issues are worth to be mentioned.…”

Section: Discussioncontrasting

confidence: 61%

“…There are few studies reporting trends in asthma medication prescriptions [1], [17]. Whereas Elkout et al reported the fraction of patients aged less than 19 years of age treated with a particular drug class [17], Baiardi et al presented the number of prescriptions for eleven compounds representing 90% of R03 (according to ATC) prescriptions given to children aged between 0 and 14 years of age [1].…”

Section: Discussionmentioning

confidence: 99%

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Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children

et al. 2014

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Respiratory drugs are widely used in children to treat labeled and non-labeled indications but only some data are available quantifying comprehensively off-label usage. Thus, we aim to analyse drug utilisation and off-label prescribing of respiratory drugs focusing on age- and indication-related off-label use. Patients aged ≤18 years documented in the Bavarian Association of Statutory Health Insurance Physicians database (approx. 2 million children) between 2004 and 2008 were included in our study. Annual period prevalence rates (PPRs) per 10,000 children and the proportion of age- and indication-related off-label prescriptions were calculated and stratified by age and gender. Within the study period, highest PPRs were found for the fixed combination of clenbuterol/ambroxol (between 374–575 per 10,000 children) and the inhaled short acting beta-2-agonist salbutamol (between 378–527 per 10,000 children). Highest relative PPR increase was found for oral salbutamol (approx. 39-fold) whereas the most distinct decrease was found for oral long-acting beta-2-agonist clenbuterol (−97%). Compound classes most frequently involved in off-label prescribing were inhaled bronchodilative compounds (91,402; 37.3%) and oral beta-2-agonists (26,850; 22.5%). The highest absolute number of off-label prescriptions were found for inhaled salbutamol (n = 67,084; 42.0%) and oral clenbuterol/ambroxol (fixed combination, n = 18,897; 20.7%). Off-label prescribing due to indication was of much greater relevance than age-related off-label use. Most frequently, bronchodilative compounds were used off-label to treat respiratory tract infections. Highest off-label prescription rates were found in the youngest patients without relevant gender-related differences. Off-label prescribing of respiratory drugs is common especially in young children. Bronchodilative drugs were most frequently used off-label for treating acute bronchitis or upper respiratory tract infections underlining the essential need for a more rational prescribing in this area.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children

et al. 2014

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“…The prescription of LABA-ICS is not frequently measured, but also increases with age. 6,12,16,22,23 In relation to maintenance treatment in other countries, inhaled corticosteroids as a single agent is generally the most prescribed subgroup, as recommended in the guidelines, followed by leukotriene receptor antagonists in second or third place. Although the prescription of montelukast is high in some countries 2,9,11,23 and almost absent in others, 6,12,17,27 which may be related to the differences at the time of the study, the population age or the prescription control has specific rules in each country.…”

Section: Discussionmentioning

confidence: 98%

Anti-asthmatic prescription variability in children according to age

Casares-Alonso¹,

Garcinuño

Blanco‐Quirós

et al. 2015

Allergologia et Immunopathologia

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“…The prescription of costly LABA ICS combination inhalers as a first-line controller in children without any prior use of ICS, the use of LABAs alone without the use of ICS, and the use of combination inhalers in children less than 5 years of age are all inept practices that have been reported elsewhere worldwide. [35][36][37][39][40][41][42][43] International asthma guidelines serve as a bridge between current knowledge and clinical practice, and as a guide to therapeutic decisions to help improve patient outcomes. Guidelines recommending management of acute asthma exacerbations have been shown to improve outcomes.…”

Section: Prescribing Patterns and Trends Of Asthma Medicationsmentioning

confidence: 99%

Cost Considerations of Therapeutic Options for Children with Asthma

Chuang

Jaffé

2012

Pediatric Drugs

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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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Changes in primary care prescribing patterns for paediatric asthma: a prescribing database analysis

Abstract: Although adherence with asthma management guidelines is not optimal, this study has identified improved adherence in primary care.

Cited by 27 publications

References 38 publications

Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children

Utilisation and Off-Label Prescriptions of Respiratory Drugs in Children

Anti-asthmatic prescription variability in children according to age

Cost Considerations of Therapeutic Options for Children with Asthma

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