This report focuses on medications dispensed for asthma (a chronic airways disease affecting children and adults) and chronic obstructive pulmonary disease (COPD, which primarily affects older adults who have been smokers). In 2013, one or more respiratory medications were dispensed to 2,042,104 people in Australia (9.1% of the population).
Inhaled corticosteroids (ICS) are highly effective in reducing symptoms and flare-ups of asthma. They are also used to reduce the frequency of disease flare-ups in people with COPD. ICS represent the most common class of respiratory medication dispensed on prescription in Australia with 6.3% of the population dispensed the drug in 2013. In that year, ICS were dispensed to slightly more females (6.9%) than males (5.7%), and to more people residing in areas of higher socioeconomic status. Dispensing of ICS was also higher among people living in major cities and regional centres compared to those in remote localities. Compared to younger Australians, people aged 65 and over were dispensed more ICS prescriptions in a year and more potent ICS formulations.
Australian guidelines for the management of asthma and COPD recommend that ICS be taken regularly rather than intermittently. However we observed that among people aged 65 and over who received any ICS in 2013, only 30% had dispensing frequencies consistent with regular use; the rate was even lower for those aged 35-64 (15.8%) and for those aged 15-34 (7.3%). Of adults (aged 15 and over) dispensed ICS in 2013, 36% received only one prescription and among these, 59% were dispensed no other respiratory medications during that year, suggesting that they did not have obstructive airways disease.
Oral corticosteroids (OCS) are recommended for treatment of flare-ups of asthma and COPD. Among those who were dispensed any respiratory medications in 2013 (and could therefore be assumed to be at risk of flare-ups of asthma and/or COPD) only 1.6% were dispensed OCS in the same year.
Long-acting bronchodilators, given as a single medication inhaler, are indicated for treatment of patients with mild to moderate COPD-who comprise the majority of people with COPD. However, in 2013, only 0.4% of Australians aged 65 and over were dispensed a long-acting bronchodilator as a single-medication inhaler. This is lower than expected in this age group.
Anti-IgE monoclonal antibody therapy (omalizumab) is the first biological medication approved for asthma management in Australia, and dispensing of this drug has steadily increased since it was listed on the Pharmaceutical Benefits Scheme (PBS) in mid-2011. The use of this medication is still quite rare in Australia, with just 298 people (0.001% of the population) being dispensed this drug in 2013.
The data analysed in this report provide evidence of substantial over- and under-use of certain classes of medications for management of asthma and COPD. These findings are important, both in terms of the missed opportunities for improved disease control, and resulting additional costs and risk of adverse effects. Further exploration of the implications of these findings will require analysis of PBS data linked to other data sources such as hospitalisation and death records, which provide more information about the patients and their medical conditions. Our findings indicate the potential both for better health outcomes and for cost savings to patients and governments by better targeting of treatment for asthma and COPD.