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Independents' Day

GPs in legal risk over steroids in children

By Daniel Cressey

GPs are leaving themselves at medicolegal risk by prescribing children with asthma potentially dangerous, unlicensed doses of inhaled steroids, a new study warns.

Prescribing experts urged GPs to audit their practice records to pick up children who were not being treated in accordance with current guidelines.

A study of more than 5,000 children aged under 12 found as many as 10 per cent were taking high-dose steroids – yet only around half were on recommended add-on therapies.

Earlier this year the National Patient Safety Agency also call-ed for audits of child inhaled steroid prescriptions following a review into the death of a five-year-old girl from adrenal suppression.

Study leader Dr Mike Thomas, General Practice Airways Group clinical research fellow at the University of Aberdeen, said: 'It was higher than we expected. There is now a strong argument GPs should be auditing their prescribing in children. I don't think it's unreasonable – it's a QOF marker to do asthma review on a yearly basis.'

Dr Thomas, a GP in Minchinhampton, Gloucestershire, added: 'Inhaled steroids are very safe in standard doses but particularly in children we should give high doses only with caution.'

In the study, published in October's British Journal of General Practice, 894 under-fives were taking inhaled steroids for asthma. Of these, 5.6 per cent were on doses greater than 400 mcg/day – the maximum recommended in the age group – 64 per cent of whom were not co-prescribed add-on therapies.

In 4,141 children aged five to 11, 3.9 per cent were on doses above the maximum licensed dose of 800 mcg/day, and 10 per cent on more than 400 mcg/day. Only 47 per cent of these were on add-ons.

Dr Stephanie Bown, director of education and communication at the Medical Protection Society, added her voice to calls for systematic auditing.

'As a method of good clinical practice and risk management it would be absolutely appropriate for practices to be auditing their prescribing practices in paediatric asthma,' she said.

'All registered medical practitioners, including GPs, have an obligation to keep up to date with current guidelines. If you don't follow guidelines the burden falls on you.'

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