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Asthma scripts concern

By Daniel Cressey

Worrying numbers of asthma patients appear to be inappropriately prescribed high-dose inhaled steroids, GP researchers warn.

Their study found GPs prescribed high doses of inhaled steroids to more than a quarter of their patients, nearly three times as many as expected.

A third of these were missing out on recommended add-on treatments, such as long-acting B2-agonists and leukotriene receptor antagonists.

One in 30 received 'potentially dangerous' doses, high enough to be above licensed use.

Study leader Dr Mike Thom-as, clinical research fellow at the department of general practice, University of Aberdeen, and

a GP in Minchinhampton, Gloucestershire, warned many GPs appeared to be ignoring current evidence and national guidelines.

He told Pulse: 'There were surprisingly high levels of high-dose inhaled steroids. We've been quite good at increasing dose to get control but maybe we haven't been so good at

reducing dose when they are controlled.

'We should audit our prescribing of high-dose inhaled steroids. We should first of all check if they still need them. The second thing is are they on add-on therapy as well? If not it should be instigated.'

Dr Thomas, a hospital practitioner in respiratory medicine, said: 'It could be easily done on GP IT systems and there's a good argument it should be part of the annual review.'

The study, published early online by the Primary Care Respiratory Journal, analysed GP prescribing data on 22,027 patients with asthma.

Some 27 per cent of patients were receiving more than 800mcg/day of inhaled steroids.

Dr Dermot Ryan, a GP in Loughborough, Leicestershire, and committee member of the General Practice Airways Group, said: 'There are a variety of reasons people are on high doses ­ most of them are due to sub-

optimal management.

'Of those on high doses some 60 per cent could step down. It's estimated only 5 to 10 per cent need doses greater than 800.'

Dr Jim Kennedy, RCGP prescribing spokesperson and a GP in Middlesex, said: 'It is important with any chronic disease and long-term prescribing that they are regularly reviewed. That's part of the reason the college pushes for regular prescription reviews at least once a year.'

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