Prescribing Advice for GPs

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MeReC Extra 44

The National Prescribing Centre has published MeReC Extra 44 (PDF) which contains information regarding a recent Cochrane review of combination therapy in asthma and use of antipsychotic drugs in dementia.

Observational data indicate that the addition of long-acting beta-agonists (LABA) is frequently given to steroid naive patients with mild asthma. A review of randomised trials conducted by the Cochrane Collaboration compared LABA and inhaled corticosteroid (ICS) therapy was not associated with a reduction in exacerbations requiring oral steroid or resulting in hospital admission when compared to ICS alone. There were some differences in some measures of lung function, frequency of short-acting beta-agonist use and symptoms.

The authors of the Cochrane review conclude that there is "insufficient evidence to support initiating therapy with a combination of inhaled corticosteroids (ICS) and long-acting ß2-agonist (LABA) rather than with inhaled corticosteroids alone". These results therefore support the current British Thoracic Society step-wise approach to treating asthma.

This MeReC Extra also discusses the results of an independent report on prescribing of antipsychotics in people with dementia. This report identified evidence of over-prescribing of antipsychotic drugs and made recommendations to the government. These recommendations have been accepted and may result in policy change. In the meantime clinicians should consider using non-pharmacological approaches to dealing with anxiety and behavioural problems if these are locally available.

Action: Clinicians who see patients with asthma or dementia will find this information useful and informative.

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