Real-life prescribing of asthmatic treatments in UK general practice over time using 2014 BTS/SIGN steps

Abstract

The 2014 British Thoracic Society (BTS) and Scottish Intercollegiate Guideline Network (SIGN) guidelines recommend a stepwise approach to asthma management. We investigated the management of asthma in primary care in the UK to understand how real-world practice compares with BTS/SIGN guidelines. Asthma patients were identified from the UK Clinical Practice Research Datalink from September 2006 to August 2016. Aims were to classify patients according to BTS/SIGN steps, describe the proportion of patients transitioning between steps and describe patient demographics and clinical characteristics per group. Overall, 647,308 patients with asthma were identified (40,096 aged 5–11 years; 607,212 aged 12–80 years). Most treated patients were in step 1 or 2 (88.3% of children/67.5% of adults in December 2007; 83.0% of children/67.0% of adults in June 2016). Most patients remained within their treatment step within a 6-month interval (>78% of children and adults throughout the study duration). The proportion of patients stepping up and down reduced from the beginning of the study, although stepping down to step 1 was relatively common in both adults and children. Few patients had a recorded asthma review in the year before reference date (18.8% of children and 14.8% of adults). Although prescribing patterns meant that most patients remained within their treatment step throughout the study, we cannot be sure that this was because their disease was truly stable. The small proportion of patients stepping up/down and the lack of recorded asthma review suggest that patients may not be treated in accordance with BTS/SIGN guidelines.

Treatment patterns among non-active users of maintenance asthma medication in the United Kingdom: a retrospective cohort study in the Clinical Practice Research Datalink

“…Our study focused on those who were being 'stepped up' to asthma maintenance therapy, as these patients represent a group who have objectively experienced an acute or sub-acute worsening of symptoms. This contrast with the approach taken by Gayle et al (22) who considered all asthmatics, regardless of severity, and the vast majority of individuals were at BTS/SIGN step 0 or step 1 which may have masked the treatment needs and trajectories of those with more severe asthma.…”

Derivation of asthma severity from electronic prescription records using British thoracic society treatment steps

“…Asthma treatment classifications such as the BTS/SIGN steps and the GINA steps have been used previously for both population-level [8,22] and individual-level analyses [32,39,40]. Previous studies using the BTS/SIGN steps have interpreted and implemented the guidelines in different ways [8,22,28,29], and indeed the guidelines have also been updated over time, making direct comparisons challenging. There are four main strengths of the methods described herein for the identification of asthma treatment regimens, and their mapping to BTS/ SIGN treatment steps.…”

“…Previous studies using the BTS/SIGN steps [8,22,28,29] have often faced some combination of three key weaknesses. First, not all possible or observed regimens map to an explicit treatment step, and thus require adhoc judgements to be made.…”

Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study

“…The findings of our study largely corroborate those found in a study in the UK. 21 Gayle et al studied real-life prescribing of asthma treatment in general practices over time. They found that most adults stayed within the same treatment step over a 6-month interval.…”