Many asthma patients exposed to high oral corticosteroids doses

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More than one quarter of 120,000 Australian asthma patients have been prescribed potentially dangerous amounts of steroid tablets, with researchers warning this puts them at greater risk of serious side-effects. Researchers, led by University of Queensland Professor John Upham, analysed data from the Pharmaceutical Benefits Scheme (PBS) to find out how often Australians with asthma were taking repeated courses of steroid tablets.

Upham said the study looked at more than 120,000 cases where asthma patients were given one or more prescriptions for steroid tablets by their doctor between 2014 and 2018. “Researchers found more than 25% of those patients were more likely to have
chronic condition,” Upham said. “Short courses of steroid tablets can be effective at treating asthma attacks in the short term, but it’s becoming clear that repeated use may cause significant long-term side-effects like diabetes, osteoporosis and cataracts.”

Around 2.5m Australians have asthma, with the condition affecting more women than men.

Upham said the best way to prevent asthma attacks was by regularly using preventer inhalers. “Unfortunately, our study found half of asthma patients given repeated scripts for steroid tablets were not using inhalers as often as they should,” he said.

“Better approaches are needed to educate and support asthma patients, and encourage them to use preventer inhalers regularly.

“This is the best way to avoid or minimise the need for steroid tablets, and the side effects they can produce.”

Researchers from the Alfred Hospital (Melbourne), University of Newcastle, Monash University, Fiona Stanley Hospital (Perth), University of Sydney, Australian National University and Concord Hospital (Sydney) were involved in the study.

Abstract
Objective: To estimate the level of dispensing of oral corticosteroids (OCS) for managing asthma in Australia, with a particular focus on the cumulative dispensing of doses associated with long term toxicity (≥ 1000 mg prednisolone‐equivalent).
Design: Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data.
Participants, setting: People aged 12 years or more treated for asthma during 2014–2018, according to dispensing of controller inhaled corticosteroids (ICS).
Main outcome measures: Number of people dispensed OCS for managing asthma during 2014–2018; proportion who were cumulatively dispensed at least 1000 mg prednisolone‐equivalent. The secondary outcome was the number of people dispensed at least 1000 mg prednisolone‐equivalent during 2018, stratified by inhaler controller dose and use.
Results: 124 011 people had been dispensed at least two prescriptions of ICS during 2014–2018 and met the study definition for asthma, of whom 64 112 (51.7%) had also been dispensed OCS, including 34 580 (27.9% of the asthma group) cumulatively dispensed 1000 mg prednisolone‐equivalent or more. Of 138 073 people dispensed OCS at this level, 68 077 (49%) were patients with airway diseases. Dispensing of diabetes and osteoporosis medications was more common for people cumulatively dispensed 1000 mg prednisolone‐equivalent or more. During 2018, 4633 people with asthma using high dose ICS controllers were dispensed 1000 mg prednisolone‐equivalent or more, for 2316 of whom (50%) controller use was inadequate.
Conclusions: Cumulative exposure to OCS in Australia reaches levels associated with toxicity in one‐quarter of patients with asthma using ICS. Cumulative dispensing of potentially toxic OCS amounts often accompanies inadequate inhaler controller dispensing. Better approaches are needed to improve adherence to controller therapy, improve outcomes for people with asthma, and to minimise the use and toxicity of OCS.

Authors
Mark Hew, Vanessa M McDonald, Phil G Bardin, Li Ping Chung, Claude S Farah, Amanda Barnard, Mark S Cooper, Peter G Gibson, John W Upham

 

University of Queensland material

 

Medical Journal of Australia abstract

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