RESEARCH - Overtreatment with inhaled corticosteroids and diagnostic problems in primary care patients

[Guest guest]

Family Practice Advance Access published online on February 27, 2008

Family Practice, doi:10.1093/fampra/cmn006

Overtreatment with inhaled corticosteroids and diagnostic problems in

primary care patients, an exploratory study

AEM Lucasa, FWJM Smeenkb, IJ Smeelec and CP van Schaycka

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@...

Received 31 March 2007; Revised 7 December 2007; Accepted 18 January 2008.

Abstract

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.

http://fampra.oxfordjournals.org/cgi/content/abstract/cmn006v1?papetoc

--

Not an MD