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GPs failing to heed official advice on asthma prescribing

The Government's medicines watchdog says GPs are ignoring its ruling to prescribe inhaled steroids alongside long-acting ?-agonists in up to 30 per cent of asthma patients.

Medicolegal experts have warned GPs it could be tough to justify going against the latest warning from the Committee on Safety of Medicines not to prescribe the long-acting

?-2 agonists salmeterol (Ser-event) and formoterol (Oxis) as monotherapy in asthma.

It gave GPs a similar warning in June after a major US trial suggested increased asthma-related deaths and serious asthma episodes among salmeterol users. The BNF contains a similar warning.

The new study of more than three million patients at 207 practices found 16,683 patients had at least one salmeterol prescription between 1991 and 2002.

Of those, 5,126 had no record of inhaled steroid use in the three months before or

after at least one salmeterol prescription and 808 had

never been prescribed steroids.

GPs can still try long-acting ?-agonists in patients provided they also prescribe at least 200µg daily of an inhaled steroid, the CSM says in this month's Current Problems in Pharmacovigilance. But neither should be used in acute asthma instead of a bronchodilator.

Dr Stephanie Bown, head of medical services (London) at the Medical Protection Society, said inadequate inhaled steroid prescribing was 'one of the commonest reasons' for

legal actions by asthma patients and added that CSM advice carried 'very considerable weight'.

She added: 'The burden is going to be on the GP to demonstrate in the particular circumstance of the case it was appropriate not to follow the guidelines.'

Medical Defence Union medicolegal adviser Dr Matt Lee said GPs should protect themselves against threat of litigation by fully informing patients flatly refusing steroids of the risks of doing so.

Former BTS chair Professor Martyn Partridge, professor of respiratory medicine at Imperial College in London, said the figures might mask appropriate monotherapeutic use of the drugs in severe chronic obstructive pulmonary disease.

But Dr Dermot Ryan, a member of the society's asthma guidelines development group, said inappropriate GP prescribing was a 'very definite' possibility.

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