Respiratory specialists at The Alfred are urging people with asthma to review their medication after new research found one quarter of people who use inhaler controllers receive potentially toxic cumulative doses of oral corticosteroid.
Oral corticosteroids (OCS) are used for treating acute asthma attacks, and sometimes for longer term control, but the risk of long-term toxicity increases with cumulative doses exceeding 1000 mg prednisolone.
New research led by our head of Allergy, Asthma and Clinical Immunology Associate Professor Mark Hew and published by the Medical Journal of Australia, analysed a 10 per cent random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data, specifically people aged 12 years or more who were treated for asthma during 2014–2018.
The study estimates almost 350,000 people with asthma in Australia were cumulatively dispensed 1000 mg oral prednisolone-equivalents or more during 2014–2018, a level associated with potential long term systemic toxicity.
Of equal concern, as many as half thepatients frequently dispensed OCS for asthma are not adhering to appropriate inhaled corticosteroid controller therapy.
Associate Professor Hew suggested patients who require OCS therapy should undergo a comprehensive asthma review by their GP, focusing on education and medication adherence.
“Until methods for objective checking of adherence and more reliable monitoring of disease activity are available, patient review should include checking their inhaler and peak flowmeter technique, updating their treatment plans, and assessing them for treatment escalation according to national guidelines or for specialist review.”
“While we did not specifically examine harms, we found that larger proportions of patients cumulatively dispensed 1000 mg prednisolone-equivalents or more, were also dispensed medications for treating diabetes or osteoporosis than of people receiving lower amounts,” he said.
“The need for frequent short courses or long-term OCS therapy is neither benign nor acceptable.”