Using the medication correctly is important to prevent asthma attacks. Asthma patients often receive a combination of medicines, namely an anti-inflammatory as a maintenance medication and a bronchodilator for when they are short of breath.
Research
Research from the Nivel and General Practice Research Institute (GPRI) shows that people who use their maintenance medication faithfully but also often need short-acting bronchodilators are more likely to have an asthma attack. Frequent use of short-acting bronchodilators can therefore serve as a signal for the GP to discuss the use of the asthma medication together with the patient.
Asthma
Asthma is a common chronic disease of the lungs; about 10% of the Dutch have asthma. The condition is often treated with a combination of anti-inflammatory maintenance medication and bronchodilators. The maintenance medication is to be inhaled by patients daily. The bronchodilators provide immediate relief when the patient is short of breath. Using the medication correctly is important to prevent asthma attacks. Studies show different outcomes about the relationship between the use of this medication and the risk of asthma attacks.
Adherence to therapy with maintenance medication
In a group of nearly 14,000 asthma patients aged 12 years and older (in 2016), Nivel and GPRI investigated the relationship between adherence to the anti-inflammatory maintenance medication, the number of prescriptions for short-acting bronchodilators and the risk of an asthma attack. Just over a third of the patients had high adherence to maintenance medication, the prescribing data showed: they had maintenance medication available for more than 80% of the days in 2016. More than a third had low adherence to therapy: they had maintenance medication at home for less than 50% of the days.
Short-acting bronchodilators
For the short-acting bronchodilators, two or more prescriptions per year are seen as frequent; In this context, ‘a lot’ can indicate insufficient control over the asthma. The recently revised NHG standard for Asthma in adults pays extensive attention to this. In total, 30% of patients received two or more prescriptions for short-acting bronchodilators in 2016, 40% did not receive any prescription for bronchodilators, and nearly 4% received more than six prescriptions.
Chances of asthma attack are higher with frequent use of short-acting bronchodilator
In 2016, 13% of the patients had an asthma attack. As patients had more prescriptions for a short-acting bronchodilator, the likelihood of having an asthma attack increased. The risk of an attack was higher with a low adherence to the anti-inflammatory maintenance medication. It was remarkable that the chance of an attack was also higher with a very high adherence. In people with a high adherence to therapy, asthma attacks are especially more common if they often use short-acting bronchodilators in addition to the maintenance medication.
Signal function of number of bronchodilators prescriptions
Frequent use of short-acting bronchodilators can serve as a signal for the GP to discuss the use of the asthma medication with the patient. It can indicate several things: it may be that patients do not inhale properly, so that the medication does not reach the right place. It can also prevent patients from being exposed to stimuli that aggravate the asthma, such as smoke or allergens. Finally, it may mean that the dose of the maintenance medication is no longer sufficient and that it needs to be adjusted.
About the research
For the study, data was used from the Nivel Care Registries First Line from 2016. Nivel investigated the relationship between adherence to anti-inflammatory maintenance medication, the number of prescriptions for short-acting bronchodilators and the risk of an asthma attack in a group of 13,756 asthma aged 12 years and older. Six out of ten patients were female, a third had no other chronic illness and a quarter had two or more other chronic illnesses. More than 80% of the patients had moderate to severe asthma.
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