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Prescribing patterns of asthma controller therapy for children in UK primary care: a cross-sectional observational
Mike Thomas1, Tarita Murray-Thomas, Tao Fan
1Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, UK. drmike.thomas@btinternet.com
Insights
Inhaled corticosteroid (ICS) monotherapy is the most common asthma controller for children in UK primary care. Prescribing patterns sometimes deviate from guidelines, with high-dose ICS or add-on long-acting beta2-agonist (LABA) used even in mild asthma.
Area of Science:
- Pediatric Pulmonology
- Pharmacotherapy
- General Practice
Background:
- Asthma management guidelines advocate a stepwise approach for pediatric anti-inflammatory controller therapy.
- This study examines real-world prescribing patterns in UK primary care.
Purpose of the Study:
- To describe asthma controller therapy prescribing patterns for children in UK primary care.
- To compare prescribing practices with established asthma management guidelines.
Main Methods:
- Retrospective observational study using the UK General Practice Research Database (2006-2007).
- Included children aged <= 14 years with a first asthma controller prescription after a 6-month washout period.
- Evaluated demographics, asthma duration, comorbidities, healthcare use, and prescribed medication doses. Physician surveys provided additional severity and utilization data.
Main Results:
- 10,004 children were identified; 90.6% received inhaled corticosteroid (ICS) monotherapy.
- ICS plus long-acting beta2-agonist (LABA) was used in 7.0%; leukotriene antagonist monotherapy in 0.9%.
- High-dose ICS was prescribed for 2.1% of children under 5 and 5.6% of those aged 5 and older. Physician-reported severity did not always align with guideline recommendations.
Conclusions:
- In UK primary care, ICS monotherapy is the predominant controller treatment across all asthma severity levels.
- Prescribing of high-dose ICS or add-on LABA occurred even in cases of intermittent or mild asthma, suggesting potential guideline non-adherence.
- Leukotriene receptor antagonists were infrequently utilized in this pediatric cohort.
Background:
Asthma management guidelines recommend a stepwise approach to instituting and adjusting anti-inflammatory controller therapy for children with asthma. The objective of this retrospective observational study was to describe prescribing patterns of asthma controller therapies for children in a primary care setting.
Methods:
Data from the UK General Practice Research Database were examined for children with recorded asthma or recurrent wheezing who, from September 2006 through February 2007, were < or = 14 years old at the time of a first asthma controller prescription after > or = 6 months without a controller prescription. We evaluated demographic characteristics, asthma duration, comorbidities, asthma-related health care resource use, and prescribed daily dose of controller medication. In addition, physicians for 635 randomly selected patients completed a survey retrospectively classifying asthma severity at the prescription date and describing therapy and health care utilization for 6 prior months.
Results:
We identified 10,004 children, 5942 (59.4%) of them boys, of mean (SD) age of 8.0 (3.8) years. Asthma controller prescriptions were for inhaled corticosteroid (ICS) monotherapy for 9059 (90.6%) children; ICS plus long-acting beta2-agonist (LABA) for 698 (7.0%); leukotriene antagonist monotherapy for 91 (0.9%); ICS plus leukotriene antagonist for 55 (0.6%); and other therapy for 101 (1.0%), including 45 (0.45%) children who were prescribed LABA as monotherapy. High doses of ICS (> 400 microg) were prescribed for 44/2140 (2.1%) children < 5 years old and for 420/7452 (5.6%) children > or = 5 years. Physicians reported asthma severity as intermittent for 346/635 (55%) patients and as mild, moderate, and severe persistent for 159 (25%), 71 (11%), and 11 (2%), respectively (severity data missing for 48 [8%]). The baseline characteristics and controller therapy prescriptions of the survey cohort were similar to those of the full cohort.
Conclusions:
Physician classifications of asthma severity did not always correspond to guideline recommendations, as leukotriene receptor antagonists were rarely used and high-dose ICS or add-on LABA was prescribed even in intermittent and mild disease. In UK primary care, monotherapy with ICS is the most common controller therapy at all levels of asthma severity.
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