Use of the inhaled corticosteroid to bronchodilator ratio in an audit of the treatment of asthma in an academic family medicine residency programme

Abstract

INTRODUCTION: Asthma affects around 5% of the United States population, with 50% having uncontrolled symptoms. AIM: To improve asthma care by seeing if the inhaled corticosteroid to bronchodilator ratio (RATIO) is associated with asthma control and if non-clinical factors were associated with adherence to asthma guidelines. METHOD: A retrospective study using University of Oklahoma-Tulsa, School of Community Medicine Family Medicine Clinic electronic medical records of a random sample of 49 patients with asthma who were seen at least twice from July 2003 through June 2007 and did not have a diagnosis of chronic obstructive pulmonary disease or exercise-induced asthma. RESULTS: The RATIO for those prescribed corticosteroid inhalers was directly related to the actual step of asthma care (STEP) but inversely related to the number of prednisone courses prescribed per year (R2=.30, p=0.0012). The difference between the actual STEP and ideal STEP (had corticosteroid inhalers been prescribed for all the months in the study) was directly related to the percent of available salbutamol (albuterol) inhalers that non-clinicians refilled and inversely related to the actual STEP (R2=.45, p=1.8 x 10-5). The available corticosteroid inhalers prescribed was directly related to the actual STEP and inversely related to the number of comorbid diagnoses addressed at the last asthma visit (R2=.70, p=5.8 x 10-10). DISCUSSION: Efforts to both limit salbutamol medications, especially by non-clinicians, and simultaneously prescribe appropriate amounts of inhaled corticosteroids, through a dedicated asthma visit, should improve asthma control. A higher RATIO implies better asthma control. KEYWORDS: Asthma; anti-inflammatory agents; albuterol; bronchodilator agents; drug therapy, combination; medical audit