New EPiC Asthma dashboard launched: How does prescribing look against asthma guidelines?

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New EPiC Asthma dashboard launched: How does prescribing look against asthma guidelines?

Media release from Matui
3 minutes to Read
Asthma

The Asthma and Respiratory Foundation New Zealand (ARFNZ) launched new asthma guidelines in 2020 and included a stepwise treatment pathway for the management of asthma in adolescents and adults.

The new He Ako Hiringa EPiC Asthma dashboard can help you to review the management of your patients with asthma against the ARFNZ best practice guidelines.

Dr Noni Richards, health researcher and EPiC Asthma co-developer says: “With the launch of EPiC Asthma, I am proud that we are able to highlight the importance of adequate management of asthma in primary care.

“As someone with asthma myself, I feel frustrated that not all people with asthma receive the care I do.”

She says national data indicates we still have some way to go to achieve equitable asthma outcomes for all patients in New Zealand.

Asthma continues to be inadequately managed and likely poorly controlled in the community. People aged over 12 years continue to be prescribed, or only pick up, SABA inhalers without maintenance treatment and many people are dispensed excessive numbers of SABA inhalers in the year.

“While this does not necessarily reflect exactly how people are managing their asthma, we know both measures are risk factors for severe exacerbations, hospital admission and mortality. These data show that for every five people aged over 12 years, prescribed (dispensed) a SABA, two will have only SABA dispensed during the year.

“These people are likely to benefit from the use of SMART/AIR therapy, where using the combined ICS/fast-onset LABA for relief of symptoms provides maintenance therapy as well.” She says He Ako Hiringa is very grateful for the guidance and input from ARFNZ.

  • The EPiC dashboard describes asthma inhaler dispensing in a cohort of people aged under 50 years either dispensed inhalers in the previous 12 months or admitted to hospital with asthma. Some of these people may have an alternative diagnosis (eg, COPD, post-covid cough or other acute respiratory illness).
  • This cohort contains 330,000 people, 78,506 Māori (13% of Māori enrolled in a PHO in New Zealand), 28,416 Pacific peoples (10.2%), 39,499 people of Asian ethnicity (6.8%) and 183,843 people of European/Other ethnicity (10.7%). There were 31,775 children aged less than 5 years (10.7% of children aged less than 5 years enrolled in a PHO in New Zealand), 53,296 children aged 5 to 11 years (11.7%) and 245,193 people aged 12 to 49 years (10%).

SABA only dispensing – inappropriate for people aged 12 and over

  • Approximately 2 in every 5 people (39%) aged 12 and over who were dispensed any SABA in the last 12 months, were dispensed SABA only, without maintenance treatment ie, without inhaled corticosteroids (alone, or in combination with a long-acting beta2 agonist LABA). The latest ARFNZ guidelines recommend that, even for patients with mild asthma, an inhaled corticosteroid (ICS) inhaler should be part of treatment, meaning there should be very few patients aged 12 and over dispensed SABA alone.
  • SABA only dispensing varies by ethnicity. Of Pacific people who were dispensed any SABA in the last 12 months, over half (55%) were dispensed SABA alone. This compares to 42 per cent of European/Other ethnicities.

Number of SABAs per year – excessive dispensing of SABA inhalers indicates poor asthma control

  • Overall, 18 per cent (approximately 1 in every 5 people) had six or more SABA inhalers dispensed in 12 months. High use of SABA is a risk factor for severe exacerbations and mortality.
  • 20 per cent of Māori and 16 per cent of Pacific people had six or more inhalers in 12 months. A significant percentage of Māori and Pacific people (13.5%) who were dispensed six or more SABA inhalers, were dispensed no maintenance therapy in that period.

Maintenance therapy – AIR/SMART or traditional ICS (±LABA) + SABA

  • ARFNZ guidelines recommend the use of AIR/SMART therapy with budesonide/formoterol for adults and adolescents with asthma. Approximately 57,000 adults and adolescents (or about 23 per cent of the total adults and adolescent asthma cohort) were using AIR/SMART in the previous 12 months.
  • In comparison, the more traditional management of asthma with inhaled corticosteroids (alone, or in combination with a LABA) and a SABA, was dispensed to approximately 156,012 people, or 47 per cent of the total asthma cohort. 122,584 people aged 12 and over, were dispensed inhaled corticosteroids (alone, or in combination with a LABA), representing about half of this population.
  • If the guidelines were followed, the majority of patients aged 12 and over would be dispensed AIR/SMART therapy with budesonide/formoterol rather than inhaled corticosteroids (alone, or in combination with a LABA) and a SABA. This is not what the data shows.
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