In asthma / COPD, combination preparations are used too quickly

According to current guidelines, patients should only start after already using a single inhalation agent

About 90,000 people receive a combination of asthma prep / MPC in the public pharmacy for the first time each year. According to current guidelines, patients should only start after already using simple inhalation agents. It still happens too little. SFK reports this week in the Pharmaceutisch Weekblad

The NHG Standards for Asthma and COPD 2015 provide a clear and detailed plan for the treatment of respiratory diseases

1) In both standards, the first step is the use of a short-acting bronchodilator, when the patient has symptoms
2) If the patient does not like it, a treatment of maintenance is added in the second step. In asthma, it is an inhaled corticosteroid anti-inflammatory and, in COPD, a long-acting bronchodilator.
3) It is only after the effect is insufficient that step 3 follows: the addition of a long-acting beta-mimetic ( bronchodilator) in asthma and inhalation of inhaled corticosteroids in people with COPD. The third step is therefore the moment when, for the first time, the combined preparations for asthma and COPD are eligible.

Distribution
The above mentioned step-by-step plan was followed at the beginning of this year by the national call for quality indicators. The results showed that in the average public pharmacy, 20% of patients used a single long-acting or inhaled beta-mimetic corticosteroid before starting with a combination preparation. Four in five patients with asthma / COPD, who do not benefit enough from the only "necessary" use of a short-acting bronchodilator (first step), therefore go directly to a preparation combined (third step). This means that the second leg of the NHG roadmap is ignored. The spread of results is also great. In the top 10% of pharmacies, the proportion of patients who had ever had a single preparation as a maintenance treatment was 32% or more; in the top 10% of pharmacies, the maximum was 9%.

Improvement
Collaboration between pharmacists and prescribers could be further improved. The measurements made by SFK during the last twelve months show that this space is also taken. From October 2017 to September 2018, more than 90,000 patients received for the first time a combination of a long-acting bronchodilator and an inhaled corticosteroid. In particular, the lowest-rated pharmacies are making progress on the 2017 calendar year, the results of which were not known until mid-March 2018. Over a six-month period, this group achieved an average increase of 2 percentage points.