Children with asthma may not be getting the best treatment for their condition, research published this morning suggests. And prescribing data from the general medical card scheme (GMS) indicates that asthma patients in the Republic may not be receiving the most cost-effective medication.
Researchers who examined prescriptions written by GPs and hospital doctors for children with asthma in the UK from 2002 to 2006 found that, contrary to guidelines on asthma management, inhaled steroids are increasingly prescribed in combination with other drugs rather than as steroid-alone inhalers.
The results published online in the Archives of Disease in Childhood show that while prescribing of steroid-alone inhalers to children gradually declined, the percentage of inhaled steroids prescribed as combination inhalers jumped from 2.6 per cent in 2000 to 20.6 per cent in 2006.
Current guidelines from the British Thoracic Society (BTS), which are also used as a standard in the Republic, state that patients should start treatment at a step most appropriate to the initial severity of their asthma.
In practice, this means 70-75 per cent of children with infrequent episodic asthma need an inhaled bronchodilator drug but do not require regular preventive therapy.
Children at step 2 of the BTS guidelines - those with frequent episodic asthma - usually require inhaled steroids or a drug known as a leukotriene receptor antagonist.
However, the authors of the study note: "Persistent asthma accounts for only 5-10 per cent of childhood asthma.
"Despite this, the percentage of prescriptions for combined therapy [ in our study] was 20.6 per cent of the total of steroid inhalers."
The increase cannot be attributed to increased asthma prevalence or demographic change they say.
"The increase in the number of combined inhalers prescribed is not consistent with the guideline recommendations that combined inhalers should only be introduced in those patients with asthma not controlled on adequate doses of inhaled steroids," the doctors from the Sydney Children's Hospital (Australia) conclude.
Latest figures from the National Centre for Pharmoeconomics (NCPE) at St James's Hospital, Dublin, mirror the UK trend.
While no specific data for under 15s is yet available, prescribing figures for the GMS (medical card) scheme show the number of prescriptions for combined asthma inhalers for patients of all ages doubled from 25,000 per month in 2002 to 50,000 per month in 2005. Expenditure also doubled to reach over €2.5 million per month in December 2005.
Commenting on the figures, Dr Michael Barry, director of NCPE, said: "Essentially we have observed a large increase in prescribing of combination products with an associated increased expenditure. So the increased trend noted in the Archives of Disease in Childhood paper is replicated here for all age groups across the country."
Dr Patrick Manning, medical director of the Asthma Society of Ireland and consultant respiratory physician at the Bons Secours Hospital, Glasnevin, told The Irish Times, "the combination therapies have been a significant advance in terms of gaining asthma control, while the current guidelines recommend that patients' asthma treatment be reassessed by their GP every three to six months."