The Woolcock Institute of Medical Research

Pharmacy dispensing records could provide a useful signal of Australians at higher risk of asthma or COPD exacerbations, according to a new Australian study published in BMJ Open.

Researchers analysed 3.84 million pharmacy dispensing records to identify medicine-use patterns associated with a higher risk of respiratory exacerbation.

One of the clearest signals was overuse of short-acting beta-agonists (SABAs), the reliever inhalers used for rapid relief of symptoms.

Among records involving SABA dispensing, 35.2% showed three or more canisters dispensed within a calendar year — the threshold used in the study to define overuse.

The figure was considerably higher among people with asthma-COPD overlap, with 62.4% reaching the overuse threshold.

At the same time, the data suggested that many patients did not have a consistent supply of preventer or controller medication.

Of the 2.4 million records containing a preventer or controller inhaler, 92.5% had enough medicine to cover less than 60% of the study period.

Together, the findings point to a concerning pattern of respiratory medicine use: heavy reliance on reliever medication alongside relatively limited supply of medicines intended to control the underlying disease.

Lead author Dr House said pharmacists could be well placed to identify these patterns because they see patients repeatedly as they collect their medicines.

Pharmacists could monitor cumulative steroid exposure, check inhaler technique and flag patients whose dispensing history suggests they may need a review by their treating doctor.

The authors described SABA overuse in particular as pointing to a “grim picture” of respiratory disease control nationally.

The study was also covered by The Limbic, which highlighted the researchers’ findings around oral corticosteroid exposure.

The researchers say the next step is to combine pharmacy dispensing data with electronic medical records and patient-reported outcomes, and test whether predictive models can identify people at increased risk in real-world clinical practice.

The ultimate goal would be to turn routinely collected pharmacy data into an earlier warning system — giving pharmacists and clinicians an opportunity to intervene before a patient experiences a serious exacerbation.

Find out more

• The Limbic: Aussie Dispensing Data Flags Steroid Overexposure Risk
• Asthma
• Dr Rachel House
• Our Clinical Management research group