USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES€¦ · Based on this survey, comparing the use of...
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139 MALAYSIAN STATISTICS ON MEDICINES 2007 CHAPTER 22 | USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES Razak A.M. 1 , Pang Y.K. 2 , How S.H. 3 , Roslina A.M. 4 , Nurul A.O. 5 , Sabrina M.S. 6 , Jaya R. 7 , Thean C.H. 8 , Leow A.Y. 9 , Aziah A.M. 8 , Liam C.K. 2 1. Pulau Pinang Hospital, 2. University Malaya Medical Centre, 3. International Islamic University Malaysia, 4. Hospital Universiti Kebangsaan Malaysia, 5. Pharmaceutical Services Division, MOH, 6. Kuala Lumpur Hospital, 7. Kulim Hospital, 8. Institute of Respiratory Medicine, 9. Clinical Research Centre, National Institutes of Health Many of the drugs used in the two common obstructive airway diseases, asthma and chronic obstructive pulmonary disease (COPD), are quite similar although the indications and the effects of drugs may differ considerably. Drug utilisation data in this survey did not differentiate between their use in asthma or COPD. Based on this survey, comparing the use of various drugs for obstructive airway diseases between 2006 and 2007, the total use of inhaled short-acting beta agonists (SABA) in 2007 has increased considerably (4.696 to 5.9347 DDD/1000 population per day). This increase was more significantly seen in private sector (from 0.3621 to 0.7926) compared to that of public sector (4.334 to 5.1421). Besides, the total use of SABA + anticholinergic combination in 2007 has also increased slightly (from 0.5213 to 0.6794), both in public and private sectors. The use of anticholinergics in private and public sectors have remained largely unchanged, in 2006 and 2007 (0.5050 vs 0.4873). In addition, compared to 2006, the use of long-acting beta agonists (LABA) in 2007 has also showed significant increase of these drugs (from 0.0273 to 0.0408). This increment is largely due to the increased usage in the public sector than the private sector. We believe that the increment is likely due to its increased usage for patients with COPD than asthma (as LABA alone therapy is not recommended for asthma). Besides, tiotropium, the long acting anticholinergic, which is indicated for COPD, has also shown an increase usage in 2007 (0.0361 to 0.1259). One notable trend is the decreasing use of inhaled single-agent glucocorticoids since 2005. In 2007, the use of inhaled glucocorticoids was showing a further downward trend (2.4159 to 1.7426) in the public sector as well as private sector. This reduction was particularly more marked in the public sector. One of the reasons could be the use of glucocorticoids + LABA combination that had increased substantially. Underuse of glucocorticoids in the treatment of asthma may lead to more patients with uncontrolled asthma and an increase use of rescue ß2 agonists. The use of oral ß2-agonists was unchanged from 2006 to 2007 (1.3484 vs 1.4171). This suggests that efforts towards encouraging doctors to change the prescription of reliever drugs from oral to inhaled route has not gained much success. The use of systemic xanthines has also remained largely unchanged in the corresponding years (1.5931 vs 1.5432). Leukotriene receptor antagonists (e.g. montelukast) are recommended for those who have mild to moderate asthma as a monotherapy or as an add-on therapy for asthmatic whose disease remains uncontrolled despite receiving other agents. 1 In 2007 survey, the use of leukotriene receptor antagoists has tripled in public sector (0.0374 to 0.0978). However, the use of these agents in private sector remained unchanged (0.1075 vs 0.0933). It is likely that more leukotriene receptor antagonists were being used as an add-on to manage poorly controlled asthma. The other reason could be that the use of this agent has increased in asthmatic with concomitant allergic rhinitis. The consumption for drugs used for obstructive airway disease in Malaysia was lower as compared to Nordic countries (12.6 vs 28.5 to 61.0). 2 Among uses of the individual drugs, the use of R03C (systemic adrenergic) was higher in Malaysia as compared to Nordic countries (1.4 versus 0.1-1.0). This is probably due to lower cost of this drug as compared to inhaled reliever therapy. The use of other respiratory agents was lower, with the exception of R03AK (adrenergic combine with other drugs) and R03D (other systemic drugs i.e xanthines and leukotriene antagonists) which were higher in Malaysia compared to Greenland. The use of drugs for obstructive airway disease in Malaysia was generally also lower as compared to Australia, where the use of combination therapy and high potency steroids (fluticasone & ciclesonide) in the treatment of asthma was higher. 3 There was also more use of inhaled long acting anticholinergics for COPD. In the case of xanthines, aminophylline was not used in Australia, while the use of theophylline in Malaysia was 5 times more than that used in Australia. In addition, the combination of SABA + short acting anticholinergics was used more often in Malaysia compared to Australia. This might suggest that in Australia, the guidelines for asthma and COPD management are more strictly adhered to, and a healthcare system which allows better access to these drugs.
Transcript of USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES€¦ · Based on this survey, comparing the use of...
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MALAYSIAN STATISTICS ON MEDICINES 2007
CHAPTER 22 | USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES Razak A.M.1, Pang Y.K.2, How S.H.3, Roslina A.M.4, Nurul A.O.5, Sabrina M.S.6, Jaya R.7, Thean C.H.8, Leow A.Y.9, Aziah A.M.8, Liam C.K.2
1. Pulau Pinang Hospital, 2. University Malaya Medical Centre, 3. International Islamic University Malaysia, 4. Hospital Universiti Kebangsaan Malaysia, 5. Pharmaceutical Services Division, MOH, 6. Kuala Lumpur Hospital, 7. Kulim Hospital, 8. Institute of Respiratory Medicine, 9. Clinical Research Centre, National Institutes of Health
Many of the drugs used in the two common obstructive airway diseases, asthma and chronic obstructive pulmonary disease (COPD), are quite similar although the indications and the effects of drugs may differ considerably. Drug utilisation data in this survey did not differentiate between their use in asthma or COPD.
Based on this survey, comparing the use of various drugs for obstructive airway diseases between 2006 and 2007, the total use of inhaled short-acting beta agonists (SABA) in 2007 has increased considerably (4.696 to 5.9347 DDD/1000 population per day). This increase was more significantly seen in private sector (from 0.3621 to 0.7926) compared to that of public sector (4.334 to 5.1421). Besides, the total use of SABA + anticholinergic combination in 2007 has also increased slightly (from 0.5213 to 0.6794), both in public and private sectors. The use of anticholinergics in private and public sectors have remained largely unchanged, in 2006 and 2007 (0.5050 vs 0.4873).
In addition, compared to 2006, the use of long-acting beta agonists (LABA) in 2007 has also showed significant increase of these drugs (from 0.0273 to 0.0408). This increment is largely due to the increased usage in the public sector than the private sector. We believe that the increment is likely due to its increased usage for patients with COPD than asthma (as LABA alone therapy is not recommended for asthma). Besides, tiotropium, the long acting anticholinergic, which is indicated for COPD, has also shown an increase usage in 2007 (0.0361 to 0.1259).
One notable trend is the decreasing use of inhaled single-agent glucocorticoids since 2005. In 2007, the use of inhaled glucocorticoids was showing a further downward trend (2.4159 to 1.7426) in the public sector as well as private sector. This reduction was particularly more marked in the public sector. One of the reasons could be the use of glucocorticoids + LABA combination that had increased substantially. Underuse of glucocorticoids in the treatment of asthma may lead to more patients with uncontrolled asthma and an increase use of rescue ß2 agonists.
The use of oral ß2-agonists was unchanged from 2006 to 2007 (1.3484 vs 1.4171). This suggests that efforts towards encouraging doctors to change the prescription of reliever drugs from oral to inhaled route has not gained much success. The use of systemic xanthines has also remained largely unchanged in the corresponding years (1.5931 vs 1.5432). Leukotriene receptor antagonists (e.g. montelukast) are recommended for those who have mild to moderate asthma as a monotherapy or as an add-on therapy for asthmatic whose disease remains uncontrolled despite receiving other agents.1 In 2007 survey, the use of leukotriene receptor antagoists has tripled in public sector (0.0374 to 0.0978). However, the use of these agents in private sector remained unchanged (0.1075 vs 0.0933). It is likely that more leukotriene receptor antagonists were being used as an add-on to manage poorly controlled asthma. The other reason could be that the use of this agent has increased in asthmatic with concomitant allergic rhinitis.
The consumption for drugs used for obstructive airway disease in Malaysia was lower as compared to Nordic countries (12.6 vs 28.5 to 61.0).2 Among uses of the individual drugs, the use of R03C (systemic adrenergic) was higher in Malaysia as compared to Nordic countries (1.4 versus 0.1-1.0). This is probably due to lower cost of this drug as compared to inhaled reliever therapy. The use of other respiratory agents was lower, with the exception of R03AK (adrenergic combine with other drugs) and R03D (other systemic drugs i.e xanthines and leukotriene antagonists) which were higher in Malaysia compared to Greenland.
The use of drugs for obstructive airway disease in Malaysia was generally also lower as compared to Australia, where the use of combination therapy and high potency steroids (fluticasone & ciclesonide) in the treatment of asthma was higher.3 There was also more use of inhaled long acting anticholinergics for COPD. In the case of xanthines, aminophylline was not used in Australia, while the use of theophylline in Malaysia was 5 times more than that used in Australia. In addition, the combination of SABA + short acting anticholinergics was used more often in Malaysia compared to Australia. This might suggest that in Australia, the guidelines for asthma and COPD management are more strictly adhered to, and a healthcare system which allows better access to these drugs.
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Table 22.1 : Use of Medicines for Obstructive Airway Diseases by Drug Class, in DDD/1000 population/day 2006-2007
ATC Drug Class AdmRCode 2006 2007
R03A A Alpha- and beta- adrenoreceptor agonistsInhal.aerosolInhal.solution
- -
R03A C Selective beta-2-adrenoreceptor agonistsInhal.aerosolInhal.powderInhal.solution
4.7234 5.9756
R03A KAdrenergics and other drugs for obstructive airway diseases
Inhal.aerosolInhal.powderInhal.solution
0.9553 1.2247
R03B A GlucocorticoidsInhal.aerosolInhal.powderInhal.solution
2.4159 1.7426
R03B B AnticholinergicsInhal.aerosolInhal.powderInhal.solution
0.5050 0.4834
R03B C Antiallergic agents, excl. corticosteroidsInhal.aerosolInhal.powderInhal.solution
- -
R03C A Alpha- and beta-adrenoreceptor agonistsOralParenteral
0.0496 0.0149
R03C B Non-selective beta-adrenoreceptor agonistsOralParenteral
--
--
R03C C Selective beta-2-adrenoreceptor agonistsOralParenteralRectal
1.3484 1.4171
R03D A XanthinesOralParenteral Rectal
1.5931 1.5432
R03D C Leukotriene receptor antagonists Oral 0.1449 0.1912
Table 22.2 : Use of Medicines for Obstructive Airway Diseases by Drug Class and Agents, in DDD/1000population/day 2006-2007
ATC Drug Class and Agents Sector 2006 2007
R03A A Alpha- and beta- adrenoreceptor agonists
R03A A01 Epinephrine
Public - -
Private - -
Total - -R03A C Selective beta-2-adrenoreceptor agonists
R03A C02 Salbutamol
Public 4.0240 4.9464
Private 0.3231 0.7211
Total 4.3471 5.6675
R03A C03 Terbutaline
Public 0.3027 0.1933
Private 0.0380 0.0458
Total 0.3406 0.2391
R03A C04 Fenoterol
Public 0.0073 0.0024
Private 0.0010 0.0257
Total 0.0083 0.0281
R03A C12 Salmeterol
Public 0.0050 0.0309
Private
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ATC Drug Class and Agents Sector 2006 2007
R03A K Adrenergics and other drugs for obstructive airway diseases
R03A K03 Fenoterol and other drugs for obstructive airway diseases
Public - -
Private 0.0226 0.0592
Total 0.0226 0.0592
R03A K04 Salbutamol and other drugs for obstructive airway diseases
Public 0.3963 0.5112
Private 0.1024 0.1091
Total 0.4987 0.6202
R03A K06 Salmeterol and other drugs for obstructive airway diseases
Public 0.1136 0.1733
Private 0.1931 0.2136
Total 0.3067 0.3869
R03A K07 Formoterol and other drugs for obstructive airway diseases
Public 0.0228 0.0705
Private 0.1046 0.0879
Total 0.1274 0.1584
R03B A Glucocorticoids
R03B A01 Beclometasone
Public 0.5609 0.4617
Private 0.0336 0.0226
Total 0.5945 0.4843
R03B A02 Budesonide
Public 1.5698 1.0263
Private 0.2171 0.1722
Total 1.7870 1.1984
R03B A05 Fluticasone
Public 0.0048 0.0267
Private 0.0020 0.0119
Total 0.0067 0.0386
R03B A07 Mometasone
Public - 0.0006
Private - -
Total - 0.0006
R03B A08 Ciclesonide
Public
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ATC Drug Class and Agents Sector 2006 2007
R03C C Selective beta-2-adrenoreceptor agonists
R03C C02 Salbutamol
Public 0.6610 0.6723
Private 0.4139 0.5031
Total 1.0749 1.1754
R03C C03 Terbutaline
Public 0.1697 0.1360
Private 0.0914 0.0871
Total 0.2611 0.2231
R03C C04 Fenoterol
Public - -
Private 0.0030 0.0085
Total 0.0030 0.0085
R03C C05 Hexoprenaline
Public - -
Private - -
Total - -
R03C C08 Procaterol
Public - -
Private 0.0064 0.0096
Total 0.0064 0.0096
R03C C12 Bambuterol
Public - -
Private 0.0030 0.0005
Total 0.0030 0.0005
R03D A Xanthines
R03D A01 Diprophylline
Public - -
Private - -
Total - -
R03D A02 Choline theophyllinate
Public - -
Private - -
Total - -
R03D A03 Proxyphylline
Public - -
Private - -
Total - -
R03D A04 Theophylline
Public 1.1004 1.0632
Private 0.4886 0.4774
Total 1.5890 1.5407
R03D A05 Aminophylline
Public 0.0028 0.0023
Private 0.0014 0.0003
Total 0.0042 0.0026
R03D C Leukotriene receptor antagonists
R03D C03 Montelukast
Public 0.0374 0.0978
Private 0.1075 0.0933
Total 0.1449 0.1912
References:1. Members of GINA Executive and Science Committees. Global Strategy for Asthma and Prevention 2009 www.ginasthma.org 2. Nordic Medico Statistical Committee. Medicines Consumption in the Nordic Countries 2004-2008. Copenhagen 20093. Australian Government Department of Health and Ageing. Australian Statistics on Medicines. 2007 13th Edition. Commonwealth of Australia 2009.
CHAPTER 22 | USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
