Asthma admission rates and patterns of salbutamol and inhaled corticosteroid prescribing in England from 2013 to 2017

Abstract

Asthma exacerbations are a common reason for hospital admission. We sought to identify whether patterns of inhaler prescribing are significantly associated with regional asthma admission rates. Asthma admission rates were obtained for English Clinical Commissioning Group (CCG) regions from 2013/2014 to 2016/2017. Raw prescribing data were obtained from OpenPrescribing.net, based on monthly general practice-level data published by the National Health Service Business Services Authority. Data were analysed using a linear mixed effects model. The ratio of salbutamol to inhaled corticosteroid prescriptions within a CCG was positively associated with asthma admission rates, independently of median age, asthma prevalence and socioeconomic deprivation.

Asthma admission rates and patterns of salbutamol and inhaled corticosteroid prescribing in England from 2013 to 2017

“…The study did not find any relationship between the asthma Quality Outcome Framework (QOF) score and admission rates. [2] This study clearly shows how the increased use of SABA over ICS to control asthma symptoms is associated with an increase in asthma-related admissions. Continuous education on appropriate class of inhaler use is necessary to remedy this global problem.…”

“…Gonem et al [2] aimed to assess the relative impact of the pattern of prescribing and quality of primary care asthma provision on asthma admission rates across the English Clinical Commissioning Group (CCG) regions from 2013 -2017. Asthma prevalence data, annual asthma admission numbers and prescribing data were collected from the National Health Service digital database from each CCG.…”

The NHS deserves better use of hospital medicines data

“…Data sharing has supported a rich ecosystem of analyses, tools, and approaches including clinical commissioning group medicines optimisation teams who monitor data and give feedback to GPs and online services that give open access to prescribing patterns and trends. Analyses conducted in this dataset have also underpinned original research on a diverse range of topics,6789101112131415 and data feedback to GPs has been shown to improve prescribing 16171819. Our group produces OpenPrescribing.net where any user can explore all prescriptions at any individual practice, explore outliers, and see changes in prescribing patterns down to the level of individual months, brands, formulations, and doses, with 135 000 unique users over the past year, as well as published peer reviewed evidence of cost savings among users 11…”

Anti-inflammatory reliever therapy for asthma

“…Notably, there is a temporal association between the ratio of SABA to ICS use and increased monthly admission rates for asthma in the United Kingdom. 2 One way of obviating the discordance between controller and reliever is to have both agents in the same single inhaler in an on demand symptom-driven regimen using so-called anti-inflammatory reliever therapy (AIR) with budesonide and formoterol. Indeed, this is now acknowledged in current global asthma guidelines, which advocate the use of needed budesonide-formoterol combination across all treatment steps on its own or in conjunction with maintenance therapydotherwise known as maintenance and reliever therapy (MART).…”