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Submission to Post-Market Review of PBS Medicines Used to Treat Asthma in Children

Submission 15 - National Prescribing Service

NPS appreciates the opportunity to address the Terms of Reference in the Post Market Review of Products Used in the Management of Asthma in Children review.

Appropriate medication and treatment management is imperative to quality use of medicines. We are available to expand on any of the issues raised in this paper.

Identify areas of prescribing for childhood asthma in Australia where clinical practice is inconsistent with clinical guidelines; and if there is evidence that supports this practice.

NPS data from a 2009 clinical audit involving inhaled corticosteroids and long-acting beta2 agonists (n=2706 under 18 years) showed that:

  • 79% of children under 5 years had been prescribed an ICS and 23% of these were receiving an ICS plus a LABA. This is inconsistent with current guidelines as LABA therapy has not been demonstrated to improve outcomes except in children with moderate to severe persistent asthma.
  • There was a high level of use of low-dose ICS in children; 83% of patients aged 0-5 years and 63% of patients aged 6-11 years. However, there were indications that GPs are using doses of ICS that may be higher than necessary in children aged 5-11 as 29% were receiving moderate to high doses.
  • GPs had attempted back titration of ICS doses in 67% of cases with children.

Identify and review recent (past 5 years) healthcare professional and consumer education in the area of medication management of children with asthma.

Asthma was a component of an asthma/COPD program in 2008 by NPS MedicineWise. There were 895 participants in total which included 605 GPs and 283 pharmacists. The key messages of this program were:

  • Select ICS and bronchodilators based on the therapeutic effect and a confirmed diagnosis
  • In persistent asthma start with a low-dose ICS. Step up or back-titrate to achieve asthma control with lowest possible dose
  • Fixed dose combinations of an ICS and a LABA should not be used for initial therapy in asthma or COPD
  • Use of budesonide with eformetrol  (Symbicort) for maintenance and reliever therapy may suit some people with poorly controlled asthma. Fluticasone with salmeterol (Seretide) is not suitable for acute relief in asthma.

Consumer focused interventions

Educational videos – asthma medicines devices

A series of videos on asthma medicine devices has been produced as part of the Collaborations in Asthma Management in the Community (CAMCOM) project. The videos were developed collaboratively by NPS and University of Sydney as part of an Australian Research Council grant to develop asthma education modules to assist health professionals become more proficient in training consumers in the use of asthma management devices. The consumer videos provide education on using asthma devices correctly, and were uploaded on the NPS website in September 2012.

Short Wind Resources – Aboriginal and Torres Strait Islander program

The short wind resources were produced by a partnership comprised of the Asthma Foundation of the Northern Territory, Danila Dilba Buluru Binnilutlum Medical Service Aboriginal Corporation and Flinders University to meet the identified need in asthma education for Aboriginal and Torres Strait Islander people in urban, remote and rural areas of Australia. The resources were later reproduced by NPS and cover: asthma medicines, how to take asthma medicine and how to use spacers and puffers. There is also a ‘short wind danger plan’ which applies the basic asthma action plan principles in a more culturally appropriate manner.

NPS MedicineWise has undertaken a number of interventions focusing on asthma.

  • Asthma was an educational focus with one on one educational visits to GPs in 2002 and a component of an asthma/COPD educational program in 2008.
  • Common themes in key messages across programs:
  • Asthma - Step up or back-titrate ICS to achieve asthma control with the lowest possible dose
  • Asthma/COPD - Fixed dose combinations of ICS and LABA should not be used as initial therapy in asthma or COPD.
  • Asthma is one of the three chronic disease modules in the Good Medicines Better Health - Aboriginal and Torres Strait Islander program.
  • Educational videos for consumers on asthma medicine devices are available on the NPS website. NPS has reproduced 'Short Wind' resources to meet an identified need in asthma education in Aboriginal and Torres Strait Islander people.
  • Asthma related consumer information resources Medicines Update and Medicines Talk are available on the NPS website.