The most effective medications for managing asthma, COPD and other obstructive airways diseases are under-used in Australia, according to a new report by Australian Centre for Airways disease Monitoring, a Collaborating Unit of the Australian Institute of Health and Welfare.
The report, Respiratory medication use in Australia 2003-2013: treatment of asthma and COPD, shows that prescription respiratory medications were dispensed to more than two million people in Australia (about 9% of the population) in 2013, but that most people only used them occasionally.
“Inhaled corticosteroids were the most common type of prescribed respiratory medication, dispensed to 1.4 million people,” says Professor Guy Marks, Director of ACAM.
When used regularly, inhaled corticosteroids are highly effective in reducing symptoms and flare-ups of asthma and can also reduce the frequency of disease flare-ups in some people with COPD. Australian guidelines for asthma and COPD recommend that inhaled corticosteroids be taken regularly rather than intermittently.
“The surprising finding was the low level of regular use of this type of medication, once prescribed,” Prof Marks says.
Even among people aged 65 and over (who are generally more consistent than younger people in taking prescribed medications), only 30% of those who were dispensed any inhaled corticosteroid appeared to use it regularly over the course of a year.
Regular use was even less common in younger age groups. Among people aged 35-64, 16% of those dispensed any inhaled corticosteroids appeared to use it regularly, while among those aged 15-34 the figure was 7%.
For people with asthma, lack of regular use of inhaled corticosteroids substantially increases the risk of a severe flare-up.
In contrast, the report also suggests over-use of some respiratory medications.
In 2013, more than one-third (36%) of adults dispensed inhaled corticosteroids received only one prescription, and among these, 59% were dispensed no other respiratory medication; this suggests that they did not have obstructive airways disease.
Prescribing of expensive or potent formulations of medications appeared to be more common than is recommended for most people with asthma or COPD. This leads to higher costs and greater risk of side effects.
“The report is concerning on two fronts-that some respiratory medications are not being taken regularly by people who would benefit from doing so, and that there appears to be a level of unnecessary prescribing for some patients,” Prof Marks says.