GPs urged to review asthma prescribing

More than 22,000 people with asthma have been prescribed long-acting reliever inhalers without an inhaled corticosteroid, a report by Asthma UK highlights.

 Patients using a short-acting reliever inhaler more than three times a week are at increased risk of an asthma attack. | SCIENCE PHOTO LIBRARY
Patients using a short-acting reliever inhaler more than three times a week are at increased risk of an asthma attack. | SCIENCE PHOTO LIBRARY

Monotherapy with long-acting reliever inhalers, either long-acting beta agonists (LABAs) or long-acting muscarinic antagonists (LAMAs), increases the risk of a life-threatening asthma attack.

Long-acting relievers keep airways opened up but do not treat the underlying inflammation, which gets progressively worse without steroid treatment. Inflamed airways make the patient more likely to react to their asthma triggers.

Current guidelines emphasise that long-acting relievers must be taken with a steroid preventer inhaler or as a combination inhaler. Combination inhalers are recommended to ensure that the reliever is not taken without the corticosteroid

The report also found that over 100,000 asthma patients have been prescribed more than 12 short-acting reliever inhalers over 12 months. Such high usage is strongly suggestive of poor asthma control and a predictor of future asthma attacks.

Asthma UK urges prescribers to: 

  • Identify patients with asthma on long-acting reliever inhalers who have not been prescribed an inhaled corticosteroid and call them in for an urgent review.
  • Be aware than any patient who is prescribed more than 12 short-acting reliever inhalers in a year is at increased risk of an asthma attack and requires prompt review.
  • Personally invite the above patients for reviews by phone, text or email. Adding a note through the Electronic Prescription Service can also reinforce the message.
  • Audit prescribing of LABAs and LAMAs and high numbers of short-acting reliever inhalers.
  • Consider switching from repeat to acute prescribing for patients with asthma, so future prescriptions can only be issued after a review.

The report follows last year’s National Review of Asthma Deaths, which identified prescribing errors in 47% of asthma deaths in primary care.

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