Appropriate use of medications is important in maximising health benefits for patients, minimising the negative effects of medications, and controlling health costs. This report focuses on the appropriate use of certain medications for the management of obstructive airways disease, including asthma and chronic obstructive pulmonary disease (COPD).
Data in this report suggest that antibiotics are commonly used among patients with asthma and COPD, and that supply patterns for inhaled corticosteroids (ICS) are often not consistent with treatment guidelines for the management of these conditions.
Use of antibiotics by people with obstructive airways disease
Antibiotics may be life-saving when used appropriately, and are recommended for treatment of bacterial infections, exacerbations of COPD, and some other respiratory conditions. However, they occasionally cause side effects. Widespread use is costly for the community and promotes the emergence of resistant strains of bacteria.
Upper and lower respiratory tract infections are a common trigger of exacerbations of asthma and COPD. Many of these are caused by viral infections and, therefore, do not respond to treatment with antibiotics.
This study has found high rates of dispensing of antibiotics to people with conditions such as asthma and COPD. In 2008, 75% of concession card holders dispensed any respiratory medication were also dispensed oral antibiotics.
Antibiotics are commonly indicated for treatment of acute exacerbations of COPD. In the cohort of people most likely to have COPD (aged 55 and over, dispensed tiotropium at least once in 2008), 78% were also dispensed oral antibiotics.
There was little difference in the dispensing of antibiotics to children with or without asthma, at about 80% in 2008.
In interpreting these findings, it is important to note that the available information does not allow us to assess the appropriateness of prescribing antibiotics in these populations.
Co-prescribing of antibiotics and one-off inhaled corticosteroids
The use of short courses of ICS as treatment for respiratory tract infections in patients without obstructive airways disease is neither supported by available evidence nor recommended in treatment guidelines.
Data in this report suggest that one-off courses of ICS are commonly co-prescribed with antibiotics, presumably for the management of symptoms of respiratory tract infections. In 2008, 44% of individuals whose dispensing record did not include any evidence that they had obstructive airways disease were co-dispensed one-off ICS with oral antibiotics.
Inappropriate prescribing of ICS increases the risk of adverse events for the patient as well as creating unnecessary cost to the public. It is estimated that in 2008 prescribing of ICS outside treatment guidelines for asthma and COPD cost the Australian Government at least $2.7 million, with a further $200,000 cost to patients.
The data presented here about prescribing practices also suggest that new strategies may be needed to assist in the diagnosis of patients presenting with respiratory symptoms in primary care. Improved diagnostic accuracy may minimise the likelihood that clinicians prescribe medication (or other therapy) that covers a number of possible diagnoses.