Abstract

Background: Asthma management in primary care may be neglected owing to time pressures, varied expertise, or a reluctance to change by health professionals and patients alike. The Global Initiative for Asthma (GINA) supports using a single inhaler containing a low to medium dose inhaled corticosteroid (ICS) plus formoterol as maintenance and reliever therapy (MART) in patients with asthma over 12 years old.
Aims: MART was prescribed to adult patients with asthma with the aims of promoting lowest effective dosing of ICS, to reduce inappropriate reliance on short acting beta-2 agonists (SABA), and to reduce the risks of exacerbations and the need for oral corticosteroids (OCS).
Method: We conducted a search of adult patients aged 17 years and older with a clinical code of asthma using the PrescQIPP Asthma Focus audit tool. The number of patients prescribed high dose ICS was measured as a proportion of all doses of ICS prescribed in the search group. Other parameters measured were the number of patients issued 6+ SABA inhalers or issued two or more courses of oral prednisolone in the preceding 12 months.
Results: The number of patients prescribed an ICS increased from 340 (44% of adults with asthma) to 620 (82.2% of adults with asthma) in 12 months. The proportion prescribed a high dose ICS reduced from 36% to 14.5%. Adult asthma patients issued with 6+ SABA inhalers reduced from 68 to 34 (50% reduction). There was a 39.5% decrease in the number of patients prescribed two or more courses of OCS in the preceding 12 months.
Discussion: This audit supports the change from SABA reliant asthma management in favour of formoterol/ICS based MART therapies to improve asthma control and reduce severe exacerbations in a primary care setting.