Prevalence of inappropriate prescribing of inhaled corticosteroids for respiratory tract infections in the Netherlands: a retrospective cohort study

Abstract

Inhaled corticosteroids (ICS) are recommended in prevailing guidelines for use in patients with persistent asthma or moderate-to-severe chronic obstructive pulmonary disease (COPD) and recurrent exacerbations. Recent data from Australia showed that 44% of patients with a single ICS dispensing and without other respiratory inhalation medications (‘one-off ICS’) were co-dispensed oral antibiotics. Evidence of the merit of ICS for treating respiratory infections in subjects without asthma or COPD is lacking. The aims of the study were to describe the rate of one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions in the Netherlands, and to compare this with the rate of one-off ICS dispensing in combination with oral antibiotics as reported earlier from Australia. Dispensing data were obtained from the Dutch Foundation of Pharmaceutical Statistics. Additional information was available on patients’ age, sex and prescriber. Patients with any ICS dispensing in 2011 were selected. Data were available from 1,725 Dutch community pharmacies (88%). Of 845,068 ICS users in 2011, 10% were dispensed one-off ICS, among which 13% had oral antibiotics co-dispensed. These ICS were mainly prescribed by general practitioners, mostly during winter months, for elderly persons, after high dosages of oral corticosteroids, and in single-inhaler combinations with a long-acting β2-agonist. The extrapolated total annual expense for this ICS use was € 555,000. In the Netherlands one-off ICS dispensing in combination with oral antibiotics in subjects without chronic respiratory conditions was considerably lower than in Australia. Inappropriate prescribing of corticosteroids for respiratory infections is less prevalent in the Netherlands than in Australia. Martina Teichert and colleagues at Radboud University in Nijmegen conducted a retrospective cohort study of the use of inhaled corticosteroids (ICS) in combination with oral antibiotics to treat respiratory tract infections in subjects without chronic respiratory conditions. There is no evidence that such use of ICS is beneficial. The study compared data from 2011 for 845,068 Dutch ICS users with published results from Australia. There was potentially inappropriate prescribing in 13% of single (“one-off”) dispensings and 1.3% of all ICS dispensings in the Netherlands. The corresponding figures from Australia were 44% and 7.3%, respectively. About €500,000 annual direct costs could be saved in the Netherlands by reductions in unnecessary prescribing.