By David Mark
New research shows Australian doctors are overprescribing a combination of asthma medications for Australian children that are potentially dangerous and, in the worst case, fatal.
The reason for the overprescribing is not clear, but one theory is the use of long-lasting preventative drugs in combination with ventolin is responsible.
The authors of a report published today in the Medical Journal of Australia argue doctors are not following guidelines and that is putting children at risk.
Peter Van Asperen is a Macintosh professor of paediatrics respiratory medicine at the University of Sydney and one of the authors of the paper.
He said there are two treatment options for asthma — reliever medications like beta antagonist or ventolin, and preventive medications.
“The aim of a preventer medication is to try and control the underlying inflammatory component of asthma … these are used in patients who are having more frequent symptoms,” he said.
The two drugs can be used in combination if patients cannot control the disease with simple preventative treatment, but Professor Van Asperen said the combination is being overprescribed.
A recent review found deaths from asthma are rare, with 20 deaths altogether within the ten-year review period.
“What was found in the death review is that the majority of those children were actually on this combination of inhaled corticosteroids and long-active beta-2 agonists,” Professor Van Asperen said.
“One of the potential downsides of long-active beta-2 agonists is that in some patients it can actually reduce the effectiveness of the short long-active beta-2 agonists, in which case, when a child has an active flare up, if they’re wheezing, medication such as ventolin … aren’t as effective as they would normally be.
“In the Australian guidelines we don’t recommend that combination therapy for children five years and under because of a lack of evidence in that age group.”
He said the combination of drugs may lead to a greater likelihood of a serious attack or death.
“It’s one possible explanation, because there has been a recent increase in deaths,” he said.
“The message is really that GPs need to be aware of these guidelines and try to follow them.”