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Non-compliance with asthma drugs sends prescribing budgets soaring

Asthma patients' failure to take prescribed medication is making a big dent in GP prescribing budgets ­ and is

responsible for up to half of

all deaths from the condition, a Government-commissioned report has warned.

The Medicines Partnership report suggested GPs should cut dosage frequencies for inhaled steroids and give patients less complex drug regimens to improve compliance.

The British Thoracic Society national asthma guidelines tell GPs that twice-daily inhaled steroids are more effective than a single daily dose.

But the new report said compliance rates with twice-daily dosing regimens in patients with mild or moderate asthma were just 48 per cent in the under-16s and 60 per cent in those aged 16-69.

Some studies suggested compliance was significantly better in patients prescribed a single daily dose, it added.

It warned that poor compliance is thought to contribute to between 18 and 48 per cent of asthma deaths.

The report said the annual primary care bill for asthma ranged from an average of £35 for a mild case to £535 for a severe case. Drugs account for 72-80 per cent of these costs and GP consultations the rest.

Professor Hugh McGavock, professor of prescribing science at Queen's University in Belfast and a former member of the Committee on Safety of Medicines, said non-compliance in asthma was costing GP drug budgets 'millions of pounds' a year.

Dr Dermot Ryan, a member of the British Thoracic Society asthma guidelines committee and a GP in Leicestershire, said good control could be achieved with a simple regimen of a combination dry powder inhaler on two doses per day. But the Department of Health had told GPs not to use dry powder inhalers because they were 'too expensive'.

He said: 'Good asthma control is expensive. Bad asthma control is even more expensive. GPs are very frustrated in their attempts to give patients a good regimen using cheap drugs.'

Dr Chris Cates, editor of the Cochrane Airways Review Group and a GP in Hertfordshire, said dry powder inhalers were 'attractive' from the point of view of compliance but would hit GP drug budgets. The data showing improved compliance by cutting dose frequency was 'only emerging', he added.

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