Poulos Leanne M, Ampon Rosario D, Marks Guy B, Reddel Helen K
Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia.
Prim Care Respir J. 2013 Jun;22(2):201-8. doi: 10.4104/pcrj.2013.00036.
Guidelines recommend regular use of inhaled corticosteroid (ICS)-containing medications for all patients with persistent asthma and those with moderate to severe chronic obstructive pulmonary disease. It is important to identify indicators of inappropriate prescribing.
To test the hypothesis that ICS are prescribed for the management of respiratory infections in some patients lacking evidence of chronic airways disease.
Medication dispensing data were obtained from the Australian national Pharmaceutical Benefits Scheme (PBS) for concessional patients dispensed any respiratory medications during 2008. We identified people dispensed only one ICS-containing medication and no other respiratory medications in a year, who were therefore unlikely to have chronic airways disease, and calculated the proportion who were co-dispensed oral antibiotics.
In 2008, 43.6% of the 115,763 patients who were dispensed one-off ICS were co-dispensed oral antibiotics. Co-dispensing was seasonal, with a large peak in winter months. The most commonly co-dispensed ICS among adults were moderate/high doses of combination therapy, while lower doses of ICS alone were co-dispensed among children. In this cohort, one-off ICS co-dispensed with oral antibiotics cost the government $2.7 million in 2008.
In Australia, many people who receive one-off prescriptions for ICS-containing medications do not appear to have airways disease. In this context, the high rate of co-dispensing with antibiotics suggests that ICS are often inappropriately prescribed for the management of symptoms of respiratory infection. Interventions are required to improve the quality of prescribing of ICS and the management of respiratory infections in clinical practice.
指南建议，对于所有持续性哮喘患者以及中度至重度慢性阻塞性肺疾病患者，应定期使用含吸入性糖皮质激素（ICS）的药物。识别不适当处方的指标很重要。
检验以下假设：在一些缺乏慢性气道疾病证据的患者中，ICS被用于治疗呼吸道感染。
从澳大利亚国家药品福利计划（PBS）获取了2008年期间获得任何呼吸道药物的优惠患者的配药数据。我们确定了一年内仅配有一种含ICS药物且未配其他呼吸道药物的人群，因此这些人不太可能患有慢性气道疾病，并计算了同时配用口服抗生素的比例。
2008年，在115763名一次性配用ICS的患者中，43.6%的患者同时配用了口服抗生素。联合配药具有季节性，冬季出现大幅高峰。成年人中最常联合配用的ICS是中/高剂量联合治疗，而儿童中则是单独配用较低剂量的ICS。在这个队列中，2008年一次性配用ICS并联合口服抗生素的费用为政府270万美元。
在澳大利亚，许多接受含ICS药物一次性处方的人似乎没有气道疾病。在这种情况下，与抗生素联合配用的高比例表明，ICS常常被不恰当地用于治疗呼吸道感染症状。需要采取干预措施以提高临床实践中ICS的处方质量和呼吸道感染的管理水平。
