Asthma quick-fix worries doctors

By MARTIN JOHNSTON health reporter

New Zealand asthmatics are using up to twice as much of a "quick-fix" puffer as they should and some are putting their health at risk.

Drug company GlaxoSmithKline calculates that New Zealand's estimated 600,000 asthmatics use their reliever puffers a million times a day.

Asthma experts agree the figures show that many patients have poorly controlled asthma and may need their medicines adjusted.

The excessive use is leaving some patients vulnerable to even more of the airway inflammation that characterises asthma.

Short-acting reliever inhalers like Ventolin are used for immediate relief of an asthma spasm.

Other puffers containing corticosteroid medicine are used to prevent attacks by treating the inflammation, which can cause scarring.

Glaxo, which makes asthma medicines, said that in the year to last September doctors prescribed nearly 1.58 million reliever inhalers. That equates to 10 puffs a week.

Robin Taylor, associate professor of respiratory medicine at the Dunedin Medical School, said yesterday that under international guidelines, taking six puffs a week from a reliever suggested poorly controlled asthma. Using five or more a day marked a patient as high risk.

He said that even though Glaxo had overstated use by wrongly assuming that all prescribed reliever medicine was inhaled - in fact some patients squirted a dose into the air for every one they took - overuse was a serious problem.

"There's a small group of patients, around 15 per cent, who use more than six puffs of Ventolin a day. That's bad news ...

"Ideally if folk are taking adequate preventer they should have little cause to use their reliever."

One risk of excessive reliever use was that patients needed higher doses for the same effect.

Another was that the airway inflammation in an asthma attack was made worse in these patients if they had also stopped using their preventer.

Professor Taylor said some people used too much Ventolin because it gave immediate relief from a spasm, while others could not afford the repeated doctor visits that might be needed to adjust corticosteroid doses.

"A quick fix is far more important to some people, particularly adolescents, than regular attention to their health."

Patients who did not use enough preventer were twice as likely as those who did to end up in hospital with an asthma-related problem.

The Asthma and Respiratory Foundation and Pharmac are concerned by the excessive use.

Medical director Professor Ian Town urged patients who were using too much reliever to see a doctor or asthma educator about preventer drugs and asthma management.

Pharmac's medical director, Dr Peter Moody, said that in line with a campaign by the agency, more people were using inhaled corticosteroids, but at lower doses than in the past.

Asthma drugs

* More than six puffs a week of a short-acting reliever, like Ventolin, indicates poorly controlled asthma.

* The need for it can be reduced by asthma prevention drugs.

* The main preventers are inhaled corticosteroids like Beclazone.

* Some patients can benefit from long-acting relievers and single-puffer combinations of them with corticosteroid.