Inappropriate asthma therapy: A tale of two countries

Introduction: Against recurrent controversies around the safety of short- and long-acting beta-agonists (SABA, LABA), and the National Review of Asthma Deaths inquiry in the United-Kingdom (UK), we investigated the prevalence of inappropriate therapy in asthma. Aims and objectives: The study aimed to determine the prevalence of inappropriate use of asthma reliever therapy in the UK and in France. Methods: Two interval, parallel, population-based cohorts (2007 and 2013),were developed in each country. The Optimum Patient Care Research Database and the Permanent Beneficiaries Sample database were used in the UK and France, respectively. Patients aged 6-40 years were identified over a 12-month period by ≥3 dispensations of asthma therapy in France and a recorded diagnosis of asthma plus ≥3 prescriptions of asthma therapy in the UK. Overuse (>12 units) of SABA, LABA without inhaled corticosteroids (ICS), and unbalanced (≥two-fold higher) use of LABA compared to ICS were studied over the 12-month periods following inclusion. Results: Overall, 39,743 UK and 4,910 French patients were included in 2007 and 14,036 and 5,657 in 2013. UK adults were more frequently exposed to SABA overuse compared to France in both periods, with an upward trend in the UK. In 2013, LABA use without ICS occurred in 0.1% and 1.5% of UK and French adults respectively (0.4% and 2.6% in 2007). Unbalanced use of LABA relative to ICS became marginal in both countries in 2013. Inappropriate use of therapy was less marked, but present, in children. Conclusions: Inappropriate therapy remains common in asthma. Based on our figures, it may be estimated that >210,000 British and >190,000 French subjects aged 6 to 40 years were inappropriately treated in 2013.