Identifying and rectifying prescriptions of long-acting antimuscarinic and beta-agonist inhalers without inhaled corticosteroids to asthma patients: an audit from a UK general practice surgery

Background In the UK 5.4 million people receive treatment for asthma. Patients diagnosed with asthma should not be prescribed a long-acting muscarinic antagonist (LAMA), or a long-acting beta 2 agonist (LABA) without co-prescription of an inhaled corticosteroid (ICS), due to the increased risk of death.

Aim To identify patients with asthma (+/− COPD), who have a current prescription for a LABA/LAMA without an ICS.

Method Audit criteria were derived from guidelines relevant to the Asthma UK national review, with standards of 100%. An electronic medical record search identified patients prescribed a LABA/LAMA without an ICS. Patients without a coded diagnosis and those with a diagnosis of asthma (+/− COPD) were identified for action.

Results Fifty-four patients from the practice population (n = 11 293) were prescribed a LABA/LAMA without an ICS. Of these, 7% (n = 4) did not have a relevant coded diagnosis. Of the remaining 50 patients, 16% (n = 8) had a diagnosis of asthma (+/− COPD). Re-audit results found 3% (n = 2) of patients did not have a relevant coded diagnosis. Patients with an asthma (+/−COPD) diagnosis on a LABA/LAMA without an ICS decreased to 11% (n = 7).

Conclusion Suboptimal coding and potentially risky prescriptions were identified. Interventions were to ensure patients have a coded diagnosis, review LABA/LAMA without ICS prescriptions, discuss audit results with practice prescribers, and to activate electronic alerts to prompt safe prescriptions. Following re-audit, the patients with asthma (+/− COPD) still on a LABA/LAMA have been offered appointments to clarify their asthma diagnosis or to explain the risks associated with LABA/LAMA prescription without an ICS.