Inappropriate asthma therapy—a tale of two countries: a parallel population-based cohort study

Abstract

Against recurrent controversies around the safety of short- and long-acting β2-agonists (SABA and LABA), and the National Review of Asthma Deaths inquiry in the United Kingdom, we investigated the prevalence of inappropriate therapy in asthma. Our study aimed to determine the prevalence of inappropriate use of asthma therapy in the United Kingdom and in France. Two interval, parallel, population-based cohorts (2007 and 2013) were developed in each country by using the UK OPCRD and the French EGB databases. Patients aged 6–40 years were studied over the 12-month period following inclusion, regarding overuse (⩾12 units) of SABA, use of LABA without inhaled corticosteroids (ICS) and ⩾2-fold higher use of LABA compared with that of ICS. Overall, 39,743 UK and 4,910 French patients were included in 2007, and 14,036 and 5,657 patients, respectively, were included in 2013. UK adults were more frequently exposed to SABA overuse compared with those in France in both periods, with an upward trend in the United Kingdom (P<0.05). In 2013, LABA use without ICS occurred in 0.1% and 1.5% of United Kingdom and French adults, respectively. Unbalanced use of LABA relative to ICS became marginal in both countries in 2013. Inappropriate use of therapy was less marked, but present, in children. Inappropriate therapy remains a common issue in asthma. Based on our figures, it may be estimated that >210,000 British and >190,000 French asthmatics aged 6–40 years were inappropriately treated in 2013.

Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program

“…Limited data on the burden of high SABA use and considerable variability in the definition of SABA 'overuse' [17,[43][44][45] have made comparisons with previous studies and regions challenging. In the SABINA program [21], the definition of high SABA use has been standardized across studies, enabling comparison and harmonization of results across geographies.…”

Clinical Factors Associated With Overuse of Asthma Reliever Medication

“…Patel et al [20] considered extreme use as >32 puffs of salbutamol in any 24-hour period. Belhassen et al [21] described SABA overuse as ≥12 prescriptions/ dispensations over 12 months, while Lynd et al [22] defined excessive use as >20 canisters in a calendar year, a criterion that was adopted in the study recently published by Tavakoli et al [23]. We evaluated reliever medication used in the previous week based on GINA and US guidelines, which indicate that more visits to the emergency department in the previous year, night awakenings in the previous 4 weeks, hospital admissions in the previous year, increases in ICS therapy in the previous year, unscheduled visits in the previous year, and upgraded therapeutic steps.…”

<p>Extrafine Beclometasone Dipropionate/Formoterol Fumarate vs Double Bronchodilation Therapy in Patients with COPD: A Historical Real-World Non-Inferiority Study</p>

“…It is a high-quality data source used regularly in clinical, epidemiological, and pharmaceutical research. 18 , 19 OPCRD is approved by the Health Research Authority for clinical research use and governed by the Anonymised Data Ethics & Protocol Transparency (ADEPT) Committee, an independent body of experts and regulators commissioned by the Respiratory Effectiveness Group (REG, http://www.effectivenessevaluation.org/ ). This study was approved by the ADEPT committee (approval reference ADEPT0419).…”