Inappropriate use of asthma drugs equals inappropriate use of health services

Despite the widespread distribution of guidelines for asthma pharmacotherapy, inappropriate use of asthma medications persists.

Current guidelines define appropriate asthma management as optimization of inhaled corticosteroid doses and use of short-acting �-agonists fewer than 4 times weekly. Dr. Aslam Anis and coworkers examined the correlation between the use of �-agonists, inhaled corticosteroid therapy and medical services among 23 986 patients. Of the 3069 (12.8%) who had prescriptions filled for 9 or more canisters of �-agonists in 1995, 763 (24.9%) used no more than 100 ug/d of inhaled beclomethasone.

The authors found that patients who inappropriately used �-agonists visited more physicians for their prescriptions (1.8 v. 1.4), were more likely to be admitted to hospital and were more likely to require emergency admission than patients who used medications appropriately. The authors conclude that their study shows that patients who use medication inappropriately are at higher risk for fatal or near-fatal asthma attacks and also use significantly more health care resources.

In a related commentary, Dr. Nicholas Anthonisen considers why patients who need inhaled corticosteroid therapy might not be using it: cost, lack of immediate symptomatic relief and failure of health care professionals to communicate its value.

Dr. Nicholas Anthonisen, Professor, Department of Internal Medicine, University of Manitoba, Winnipeg; tel 204-787-2562

Double trouble: impact of inappropriate use of asthma medications on the use of health care resources � A.H. Anis et al

Guidelines do matter � N. Anthonisen