Family Practice Advance Access originally published online on February 27, 2008
Family Practice 2008 25(2):86-91; doi:10.1093/fampra/cmn006
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Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients, an exploratory study
a Department of General Practice, Research Institute Caphri, Maastricht University, Maastricht
b Department of Pulmonary Diseases and Tuberculosis, Catharina Hospital, Eindhoven
c COPD & Asthma Primary Care Group (CAHAG), Utrecht, The Netherlands
Correspondence to AEM Lucas, Department of General Practice (HAG), Research Institute Caphri, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Email: annelies.lucas{at}hag.unimaas.nl
Received 31 March 2007; Revised 7 December 2007; Accepted 18 January 2008.
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Abstract |
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Background. Underdiagnosis and undertreatment of patients with asthma or chronic obstructive pulmonary disease are widely discussed in the literature. Not much is known about the possible overdiagnosis and consequently the overtreatment with inhaled corticosteroids (ICS).
Aim. This study investigates how often ICS are prescribed without a proper indication and how big the diagnostic problem is caused by inappropriate prescription and use of ICS.
Methods. All patients referred to a primary care diagnostic centre during 6 months who used ICS without a clear indication were included. Their GPs were questioned about the reasons for prescribing ICS. If still no diagnosis could be assessed, GPs were advised to stop ICS and renew spirometry after a steroid-free period of at least 3 months. After 1 year, the use of ICS was evaluated and the diagnoses were reassessed.
Results. Of all referred patients (2271), 1171 used ICS, 505 (30%) without a clear indication. After 1 year, final results showed that 11% of all patients originally using ICS had no indication to use ICS and had successfully ceased using this mediation. For 15%, the reasons for using ICS remained unclear.
Conclusions. Overtreatment with ICS in primary care seems to be considerable, which falsely labels patients as asthmatic and which generates unnecessary costs and possible side effects. The awareness of GPs of the need for proper diagnostic testing before prescribing ICS needs to be improved. Overtreatment with ICS in primary care patients can be diminished by systematically supporting the GP in the diagnostic procedures and decision making.
Keywords. Asthma, COPD, overtreatment, primary care, use of ICS.
Lucas AEM, Smeenk FWJM, Smeele IJ and van Schayck CP. Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients, an exploratory study. Family Practice 2008; 25: 86–91.