Australian preschoolers are being inappropriately prescribed fixed dose combination (FDC) asthma medication, according to a new UNSW Sydney big data study.
This type of asthma inhaler contains a combination of two medicines and should only be prescribed when inhalers with a single preventative medicine (called inhaled corticosteroid, or ICS) are ineffective in controlling asthma symptoms.
But according to the findings, 88 per cent of FDC inhalers dispensed to children and adolescents aged between one and 18 are prescribed as a first line of controller therapy.
“Most alarmingly, in our study cohort – which looked at 10 per cent of the Australian population – we found that around 3,500 Australian children aged five or under are dispensed FDC inhalers annually,” says Respiratory Epidemiologist and lead author of the study, Dr Nusrat Homaira.
“According to national asthma guidelines, children aged five or under shouldn’t be prescribed FDC inhalers at all.”
The findings, published in the International Journal of Environmental Research and Public Health, come two years after the Pharmaceutical Benefits Advisory Committee (PBAC) made recommendations that FDC dispensing patterns in children were ‘unacceptably high’ and needed to change.
According to the Australian Asthma Handbook, created by the National Asthma Council, children and adolescents aged between six and 18 should only be prescribed FDCs after trying an initial therapy with ICS.
This ‘step-up’ approach to asthma management aims to minimise potential risks of prescribing the medication to young children.
“There is lack of evidence suggesting benefit of FDC in children – especially in preschoolers,” says Dr Homaira.
“Some data suggests it may even increase risk of asthma exacerbation and result in development of tolerance to asthma relievers in young children.”
The UNSW medical researchers used a set of routinely collected dispensing data from the Pharmaceutical Benefits Scheme (PBS), provided by Services Australia.
The randomised data set included almost 36,000 children and adolescents aged 1−18 years who were dispensed at least one FDC between January 2013 and December 2018.
Of this sample, more than 31,000 didn’t have a preceding ICS prescription.
The study is the first data analysis on national asthma dispensing patterns since 2014.
Dr Homaira stresses that despite these high dispensing rates, asthma dispensing patterns are improving.
“Overall, FDC dispensing in children – and more importantly, FDC dispensing without a preceding ICS – is declining in Australia,” she says.
“In 2013, around 15 in every 1000 children were prescribed an FDC inhaler. By 2018, this dropped to around seven in every 1000 children.
“More work needs to be done, but we are moving in the right direction.”