title: Inappropriate asthma therapy-a tale of two countries: a parallel population-based cohort study.
abstract: Against recurrent controversies around the safety of short- and long-acting β2-agonists (SABA and LABA), and the National Review of Asthma Deaths inquiry in the United Kingdom, we investigated the prevalence of inappropriate therapy in asthma. Our study aimed to determine the prevalence of inappropriate use of asthma therapy in the United Kingdom and in France. Two interval, parallel, population-based cohorts (2007 and 2013) were developed in each country by using the UK OPCRD and the French EGB databases. Patients aged 6-40 years were studied over the 12-month period following inclusion, regarding overuse (⩾12 units) of SABA, use of LABA without inhaled corticosteroids (ICS) and ⩾2-fold higher use of LABA compared with that of ICS. Overall, 39,743 UK and 4,910 French patients were included in 2007, and 14,036 and 5,657 patients, respectively, were included in 2013. UK adults were more frequently exposed to SABA overuse compared with those in France in both periods, with an upward trend in the United Kingdom (P<0.05). In 2013, LABA use without ICS occurred in 0.1% and 1.5% of United Kingdom and French adults, respectively. Unbalanced use of LABA relative to ICS became marginal in both countries in 2013. Inappropriate use of therapy was less marked, but present, in children. Inappropriate therapy remains a common issue in asthma. Based on our figures, it may be estimated that >210,000 British and >190,000 French asthmatics aged 6-40 years were inappropriately treated in 2013.
authors.affiliation: PELyon, HESPER 7425, Claude Bernard University, Lyon, France.
authors.forename: Manon
authors.initials: M
authors.lastname: Belhassen
authors.affiliation: Research in Real Life Ltd, Cambridge, UK.
authors.forename: Anjan
authors.initials: A
authors.lastname: Nibber
authors.affiliation: PELyon, HESPER 7425, Claude Bernard University, Lyon, France.|Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Ganse
authors.affiliation: Centre of Population Health Studies, University of Edinburgh, Edinburgh, UK.|Optimum Patient Care Ltd, Cambridge, UK.
authors.forename: Dermot
authors.identifier: 0000-0002-4115-7376
authors.initials: D
authors.lastname: Ryan
authors.affiliation: PELyon, HESPER 7425, Claude Bernard University, Lyon, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Langlois
authors.affiliation: Optimum Patient Care Ltd, Cambridge, UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Appiagyei
authors.affiliation: Optimum Patient Care Ltd, Cambridge, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Skinner
authors.affiliation: PELyon, HESPER 7425, Claude Bernard University, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Laforest
authors.affiliation: Research in Real Life Ltd, Cambridge, UK.|Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Soriano
authors.affiliation: Research in Real Life Ltd, Cambridge, UK.|Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists