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Restrictions on combined asthma inhalers put patients at risk

By Nigel Praities

PCTs that restrict use of combined inhalers for asthma are ignoring the evidence and endangering patients, UK researchers warn.

Their ‘remarkably strong' findings indicate that use of combined inhalers brings superior control, better compliance and lower use of healthcare resources than inhalers prescribed separately.

GP warned last year that PCTs ‘obsessed' with cutting costs were switching patients with asthma to cheaper inhalers without offering them a consultation with a doctor.

The new study, using the UK general practice research database, backs up those concerns.

Researchers at the University of Aberdeen found over a third of patients on combined inhalers were successfully controlled for their asthma, compared with only 25% on single inhalers. Patients on combined inhalers also used less oral steroids, were more compliant and less likely to be admitted to hospital.

Professor David Price, a GP in Norwich and professor of primary care respiratory medicine at the University of Aberdeen, said the findings were ‘remarkably strong' and clearly demonstrated the benefits of combined inhalers.

‘The danger with single inhalers is that patients did not take enough inhaled steroid. If you are not taking enough anti-inflammatory therapy, you may ease symptoms, but you will actually run the risk of poorly controlled disease,' he explained.

NICE guidelines released in March said the decision to use a combination inhaler for asthma in adults and children should be made on ‘an individual basis', taking compliance and the therapeutic need into consideration.

Professor Price said cost-conscious PCTs had put ‘cost-containment before common sense' and should now reconsider their position in the light of this new data and the NICE guidance on inhalers.

‘I think if a PCT was ignoring the general tenor of NICE I think the balance of evidence is against it. Alright it is only grade B evidence, but you still can't ignore it,' he said.

Dr Iain Small, a GP in Peterhead and chair of the General Practice Airways Group, said his main concern over single inhalers was that lack of concordance was ‘potentially life-threatening' in asthma.

‘The most expensive asthma therapy is one that is not taken at all,' he insisted.

The research will be presented at the International Primary Care Respiratory Group World Conference in Seville next month.

'remakably strong' findings indicate that use of combined inhalers works better ‘remarkably strong' findings indicate that use of combined inhalers works better

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