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December 2016

East Midlands Respiratory Programme

Click xlsxhere for Prescribing Data

The prescribing data for several respiratory products presented in the following charts represents comparative data i) across CCG’s, ii) across products and iii) over time - the last 3 years (2013-2016) for the East Midlands. We hope it provides meaningful data with which to develop pathways and monitor. The data is presented for information for CCGs at a time where there is interest in optimising patient management for COPD and asthma and many CCGs are developing local disease protocols.

Please bear in mind, that whilst some of the products are specifically licensed for asthma or COPD, many are used in both conditions and it is not possible to separate them out. Further, we are aware that some are used off-license.

There are several new products coming onto the market for COPD and asthma. It is key that potential short-term small cost savings per item are not driving mass switch overs, particularly where device changes are required.

If for any reason, a device change is being considered, each patient should be invited to visit for an inhaler review. They should be taught and assessed using the new device to ensure they are able to use and then give consent for the change. Changing an inhaler device by letter is not good practice. Even if a device does not change, patients deserve to be informed if the name and packaging change and reminded of the role and use of of that inhaler.

Please note, the Y axis on the graphs differ considerably between graphs.

Analysis

For each CCG, there might be different patterns emerging. We will be happy to discuss these with individual CCG’s but encourage discussion on interpretation across commissioners, clinicians and pharmacists

Some general comments:

· Many patients with COPD were previously put on an unlicensed MDI (metered dose inhaler) Seretide® if unable to take the licensed Seretide® 500 accuhaler. Now alternative licensed MDIs for COPD exist such as pMDI Fostair® or patients are put on alternative devices such as the turbohaler Symbicort®

· Carbocisteine is a mucolytic that is recommended in certain patients where there are thick, tenacious secretions. Any benefit should be assessed and if present, can be continued titrating the dose to need and using when needed. However, it should go along with other measures including airways clearance techniques and reviewing other causes of thick sputum. If there is no benefit with carbocisteine, it should be stopped.

· Several preparations have a sharp increase representing their addition to a formulary or new license.

· Longitudinal analysis permits monitoring of how certain interventions may affect prescribing.


Charlotte Bolton and Jane Scullion December 2016