Is higher population‐level use of ICS/LABA combination associated with better asthma outcomes? Cross‐sectional surveys of nationally representative populations in New Zealand and Australia. Issue 8 (9th August 2017)

• Record Type: Journal Article
• Authors: Reddel, Helen K.; Beckert, Lutz; Moran, Angela; Ingham, Tristram; Ampon, Rosario D.; Peters, Matthew J.; Sawyer, Susan M.
• Is Part Of: Respirology. Volume 22:Issue 8(2017)
• Page Start: 1570
• Page End: 1578
• Publication Date: 2017-08-09
• Subjects: antiasthmatic agents/therapeutic use -- asthma -- asthma/epidemiology -- asthma/therapy -- cross‐sectional studies; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.13123
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma‐related outcomes between these countries. Methods: A web‐based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web‐based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. Results: NZ ( n = 537) and Australian ( n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)‐containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long‐acting β2 ‐agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use ( P < 0.0001). Adherence was higher with ICS/LABA than ICS‐alone ( P < 0.0001), and higher in NZ than in AU ( P < 0.0001). ACT scores were similar ( P = 0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non‐urgent asthma reviews (56.6% vs 50.4%; P = 0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P = 0.75). Conclusion: This comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS‐containing medications. The greater use of ICS‐alone in NZ relative to ICS/LABA does not appear to have compromised population‐level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings. Abstract : See related Editorial Poor asthma symptom control and urgent healthcare episodes remain common in New Zealand (NZ) and Australia (AU). More costly inhaled corticosteroid (ICS)/long‐acting β2 ‐agonist (LABA) use was strikingly higher in AU, but NZ achieved similar outcomes with wider use of cheaper ICS monotherapy and better adherence. Pharmaceutical regulation, patient costs and patterns of clinical practice are likely influences.