title: Inappropriate prescribing of combination inhalers in Northern Ireland: retrospective cross-sectional cohort study of prescribing practice in primary care.
abstract: BACKGROUND
  Asthma management guidelines advocate a stepwise approach to asthma therapy, including the addition of a long-acting bronchodilator to inhaled steroid therapy at step 3. This is almost exclusively prescribed as inhaled combination therapy.
  
  
  OBJECTIVE
  To examine whether asthma prescribing practice for inhaled combination therapy (inhaled corticosteroid/long-acting β2-agonist (ICS/LABA)) in primary care in Northern Ireland is in line with national asthma management guidelines.
  
  
  METHODS
  Using data from the Northern Ireland Enhanced Prescribing Database, we examined initiation of ICS/LABA in subjects aged 5-35 years in 2010.
  
  
  RESULTS
  A total of 2,640 subjects (67%) had no inhaled corticosteroid monotherapy (ICS) in the study year or six months of the preceding year (lead-in period) and, extending this to a 12-month lead-in period, 52% had no prior ICS. 41% of first prescriptions for ICS/LABA were dispensed in January to March. Prior to ICS/LABA prescription, in the previous six months only 17% had a short-acting β2-agonist (SABA) dispensed, 5% received oral steroids, and 17% received an antibiotic.
  
  
  CONCLUSIONS
  ICS/LABA therapy was initiated in the majority of young subjects with asthma without prior inhaled steroid therapy. Most prescriptions were initiated in the January to March period. However, the prescribing of ICS/LABA did not appear to be driven by asthma symptoms (17% received SABA in the previous 6 months) or severe asthma exacerbation (only 5% received oral steroids). Significant reductions in ICS/LABA, with associated cost savings, would occur if the asthma prescribing guidelines were followed in primary care.
authors.affiliation: Centre for Infection and Immunity, Queen's University of Belfast, Belfast, UK.
authors.forename: Joan
authors.initials: J
authors.lastname: Sweeney
authors.forename: Chris C
authors.initials: CC
authors.lastname: Patterson
authors.forename: Stephen
authors.initials: S
authors.lastname: O'Neill
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.forename: Gillian
authors.initials: G
authors.lastname: Plant
authors.forename: Veranne
authors.initials: V
authors.lastname: Lynch
authors.forename: Teresa
authors.initials: T
authors.lastname: McAllister
authors.forename: Liam G
authors.initials: LG
authors.lastname: Heaney
mesh_terms: D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D009330:Nebulizers and Vaporizers; D009660:Northern Ireland; D011320:Primary Health Care; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents