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Prescriptions Patterns Show Physicians Too Quick to Prescribe Long-Acting Beta Agonists as Rescue Meds for Asthma: Presented at AAAAI

By Bryan DeBusk

SAN DIEGO, CA -- February 27, 2007 -- A review of administrative claims data shows that many asthma patients may be inappropriately using long-acting beta agonists (LABAs) as rescue inhalers, according to findings presented here at the 2007 American Academy of Allergy, Asthma, and Immunology (AAAAI) annual meeting.

Current guidelines for treating patients with mild to moderate persistent asthma discourage the use of LABAs as a result of observations that these medications may increase the risk of death or severe symptoms when asthma attacks do occur.

To determine whether physicians were following these guidelines, researchers at the University of Arkansas for Medical Sciences and the Arkansas Children's Hospital Research Institute examined prescription patterns for a commonly prescribed LABA in the Arkansas Medicaid population from July 2004 through the end of 2005.

The results were presented by first author Mark Helm, MD, MBA, medical director, Evidence-Based Prescription Drug Program, and assistant professor of pharmacy practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States.

Dr. Helm and colleagues focused on 2,257 patients who first received a prescription for Advair in the first 6 months of 2005. Although 79% of these patients received a diagnosis of asthma, 11% had a history of receiving inhaled steroids. Additionally, 1 in 5 of these patients did not visit a doctor or hospital during the study period, which suggests that they requested their prescriptions over the phone, he said.

In his poster presentation on February 26^th, Dr. Helm said the researchers were surprised to find that only 51% of the patients who received a prescription for Advair filled it at least once during the following 6 months, and only 13% filled the prescription 4 or more times.

"This is a daily controller medicine," said Dr. Helm. "The fact that there's no short-acting beta agonist being used [by most of this group] makes me believe that this medicine may have been used as a rescue medicine rather than as a controller."

The researchers concluded that many physicians were deviating significantly from the guidelines for treating mild to moderate persistent asthma and the specific prescribing information for Advair.

Physicians in Arkansas who care for asthma patients on Medicaid have seen some changes as a result of the study. Advair and other LABAs are now on a prior authorisation list that requires physicians to call the Medicaid program to request an authorisation for patients who have not filled a prescription for an inhaled steroid during at least 4 of the previous 6 months.

Dr. Helm noted that the changes are not intended to be a burden for physicians and patients. "If they're following step therapy, the prior authorisation [required] will have no effect," he said. "But if they're not, this is an indication to the physician that the patient is not actually following through with their chronic controller therapy as they should."

Tamara Perry, MD, paediatric allergist and asthma specialist, Arkansas Children's Hospital, Little Rock, Arkansas, United States, said she modified the way she prescribes LABAs after learning about the study. She commented, "[The study] has shown us that we may skip a step in the asthma guidelines. We've not really seen an increase in exacerbations now that we've switched some of our patients off those medications and onto the single inhaled corticosteroid medications."

"Advair is a great drug for patients who have moderate to severe persistent asthma," he says, "but not every patient who shows up with an exacerbation has moderate to severe persistent asthma. If this medication is not being used as a controller, then there are some issues the physician needs to deal with."


[Presentation title: Advair Prescribing Patterns in a State Medicaid and Child Health Insurance Program. Poster 668]

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