Related Experiment Video
Updated: Dec 12, 2025
Dry Powder and Nebulized Aerosol Inhalation of Pharmaceuticals Delivered to Mice Using a Nose-only Exposure System
Published on: April 6, 2017
Dispensing Practices of Fixed Dose Combination Controller Therapy for Asthma in Australian Children and Adolescents
Nusrat Homaira1,2, Benjamin Daniels3, Sallie Pearson3
1Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Sydney 2052, Australia.
Insights
Fixed-dose combination (FDC) asthma medications are not recommended for young children. While inappropriate FDC use in children under 5 years old is declining, 88% of FDC initiations lacked prior inhaled corticosteroid (ICS) therapy.
Area of Science:
- Pediatric Pulmonology
- Pharmacoeconomics
- Public Health Policy
Background:
- Australian guidelines advise against fixed-dose combination (FDC) asthma controller medications for children under 5 years.
- FDCs are recommended for children aged 6-18 years only if initial inhaled corticosteroid (ICS) therapy is insufficient.
Purpose of the Study:
- To analyze trends in FDC dispensing for pediatric asthma in Australia from 2013-2018.
- To assess the proportion of FDC initiations without prior ICS use.
- To determine the financial cost of FDCs to the government and patients.
Main Methods:
- Utilized Pharmaceutical Benefits Scheme dispensing claims data from 2013 to 2018.
- Examined annual incident FDC dispensing and FDC dispensing without preceding ICS.
- Calculated the cost burden of FDCs.
Main Results:
- 35,635 FDC initiations occurred between 2013-2018, with 88% lacking prior ICS dispensing.
- Overall FDC dispensing incidence decreased from 14.7 to 7.2 per 1000 children.
- Incidence of FDC dispensing without prior ICS declined across all age groups, notably in younger children.
Conclusions:
- Despite inappropriate FDC use in children under 5, overall FDC dispensing and initiation without prior ICS are decreasing in Australia.
- The study highlights a significant trend towards more appropriate asthma medication management in children.
- Further monitoring is warranted to ensure adherence to guidelines and optimize asthma care.
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.
Related Concept Videos
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:29Drug Dosing: Infants and Children
01:23Inhaled Medications
01:01Dosage Regimen: Fixed Dose
Fixed-dose regimens can be used for various routes of administration, including intravenous (IV) injections and oral medications. For IV administration, a predetermined amount of the drug is...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:30Asthma-IV: Nursing Management
First, in...