Tertiary care center providers prescribe ‘select agents’ in asthma inhalers

Key takeaways:

• For mild to moderate asthma, many providers reported prescribing a 110 µg/actuation fluticasone metered dose inhaler.
• Few providers prescribed inhaled steroids/long-acting bronchodilator inhalers.

WASHINGTON —Tertiary care center providers generally reported similar asthma inhaler practices despite being from different disciplines, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Using results from a survey on asthma inhaler practices sent to various providers and pediatric/medicine-pediatric residents, Michelle Manious, MD, MS, fellow in the department of allergy and immunology at Children’s Mercy Kansas City, and colleagues assessed responses from 144 providers to gain an understanding of how inhaler prescription practices vary within a tertiary care center.

Most of the providers who participated did not specialize in asthma (n = 126), but the remaining 18 providers did specialize in asthma as allergy and pulmonology providers.

Researchers found that more providers prescribed green zone controller medications vs. yellow zone therapy (122 providers vs. 100 providers).

Among those prescribing green zone inhaled steroids (ICS), which are given to patients who are doing well with no asthma symptoms, 97.5% reported prescribing fluticasone metered dose inhaler 110 µg/actuation for mild to moderate asthma.

Notably, a small number of providers reported prescribing green zone ICS/long-acting bronchodilator (LABA) inhalers (n = 40), and this type of inhaler was prescribed less often because providers said they would rather refer the patient to a subspecialist.

Of the various agent combinations involved in ICS/LABA inhalers, researchers noted that providers preferred budesonide-formoterol.

In terms of yellow zone practices, which are prescribed when patients experience an “acute loss of asthma control and increase of asthma symptoms two or more times per day greater than baseline, increased use of rescue medications and increase in nocturnal symptoms,” Manious said during her presentation, providers often reported increasing albuterol use frequency (n = 61; 65.6%) and doubling ICS (n = 54; 58.1%).

Following symptom improvement, researchers found that 64.8% of providers recommended yellow zone therapy for 2 weeks.

“Although many ICS and ICS/LABA agents exist, most survey respondents utilize select agents for asthma management, and this may be due to insurance restrictions or cultural prescribing practices,” Manious said. “The data from this study suggests an opportunity to educate providers on various inhalers available for the management of asthma.”

References:

• Asthma action plans. https://asthma.net/living/asthma-action-plans. Published Feb. 20, 2016. Accessed March 4, 2024.
• Manious M, et al. J Allergy Clin Immunol. 2024;doi:10.1016/j.jaci.2023.11.330.