Accurate diagnosis needed to prescribe the right medicines for respiratory infections

In 2008, inappropriate prescribing of inhaled corticosteroids (ICS) is likely to have cost the community nearly $3 million, according to a report released today by the Australian Institute of Health and Welfare (AIHW).

The report, Medications prescribed for people with obstructive airways disease: antibiotics and inhaled corticosteroids, shows that 44% of people whose records suggested that they had a short term respiratory infection but did not have obstructive airways disease received short term inhaled corticosteroids with oral antibiotics.

'The use of short courses of ICS as treatment for respiratory tract infections in patients without obstructive airways disease such as asthma or chronic obstructive pulmonary disease (COPD) is not supported by available evidence nor recommended in treatment guidelines,' said Professor Guy Marks, from the AIHW's Australian Centre for Asthma Monitoring.

'Inappropriately prescribed ICS increases the risk of adverse events for the patient as well as creating unnecessary cost to the public.'

The report also suggests that antibiotics are commonly used to treat patients with asthma and COPD.

'Antibiotics may be life-saving when used appropriately, and are recommended for treatment of bacterial infections, exacerbations of COPD, and some other respiratory conditions,' Professor Marks said.

However, they occasionally cause side effects, create unnecessary cost for the community and can contribute to resistant strains of bacteria.

'In our report we suggest that new strategies may be needed to assist clinicians in diagnosing patients with respiratory symptoms,' said Professor Marks.

'Improved diagnostic accuracy could minimise the likelihood that clinicians prescribe medication that covers a number of possible diagnoses, but may not be appropriate for the individual's condition.'

The report also shows 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. Among people most likely to have COPD, 78% were also dispensed oral antibiotics. The report was unable to determine whether or not these prescriptions were appropriate.

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.

The AIHW is a major national agency set up by the Australian Government to provide reliable, regular and relevant information and statistics on Australia's health and welfare.


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