Doctors are overprescribing a combination of asthma medicines which could prove fatal to some children, a leading Australian respiratory expert and paediatrician has warned.
Professor Peter van Asperen, a senior respiratory specialist at the Children’s hospital at Westmead, said doctors were failing to follow guidelines for asthma management in children, leading to drugs being inappropriately prescribed and lives being put at risk.
An audit of child deaths in NSW had found 20 children up to the age of 17 had died between 2004 and 2013, with a recent increase in deaths, Van Asperen wrote in the Medical Journal of Australia.
Of those, 15 had inhaled drug combinations of corticosteroid, an anti-inflammatory used to prevent an asthma attack, and a long acting beta-agonist, which relaxes the airways, the report published on Monday found.
But National Asthma Council Australia guidelines state this combination should not be used as a first-line treatment for children, because it can reduce the effectiveness of other asthma medications taken when an attack occurs.
“When we are dealing with asthma at the more severe end of the spectrum, this prescribing may be appropriate,” Van Asperen said.
“But I think we’ve been aware for some time that there has been a tendency for this combination to be prescribed as a first-line preventer, even though they should really be reserved for patients who have been through other treatments and are not responding.”
In some patients, prescribing the combination drug made short-acting beta-agonists such as Ventolin, which rapidly open up the airways, less effective, he said.
“If that were to occur, then potentially you may get a more severe flare-up that’s also not as responsive to the usual treatment, so that’s another possible explanation of the recent increase in deaths,” he said.
Because the number of deaths were still small overall it was hard to prove causality, Van Asperen said.
“But it highlights we need to think carefully about what medicines children are being prescribed, and follow guidelines to avoid overuse,” he said.
The combination corticosteroid and long acting beta-agonist treatment was not recommended for children under five, he said.
Other potential factors contributing to an increased risk of death included asthma medications not being used as recommended, poor asthma control or medication adherence, and a lack of follow-up care, the report found.
It was still unknown exactly what caused asthma, Van Asperen said, but he said symptoms often settled down as children became older.
He recommended educational strategies to help GPs prepare written action plans for patients and better promotion of asthma management guidelines to doctors.