Oral corticosteroids for asthma usually prescribed by non-specialists

Background: The frequent use of regular and acute oral corticosteroid (OCS) treatment is identified as a key challenge in asthma management. To raise awareness about the burden of OCS and the potential of new treatments available, information about who prescribes OCS is useful. Aim: To explore the involvement of specialists in the prescriptions of regular OCS or frequent (≥2) OCS courses in asthma. Methods: We analysed OCS prescription data from 1430 pharmacies (Dutch IQVIA Prescription Database) focusing on adult patients receiving asthma medication in focus yr 2017. Prescribers were classified as specialist or general practitioners (GP). Regular OCS was defined as >28 days ≥2.5mg - ≤17.5mg and OCS courses as Results: Of 185.783 adults on asthma medication, 76.5% had no OCS prescription in the focus yr, 2.5% received ≥2 OCS courses and 4.6% regular OCS. Regular OCS or ≥2 OCS courses were prescribed across the whole range of ICS doses and in 38.9% of these cases OCS was prescribed by a specialist. In the subgroup of 79.274 patients on high dose ICS, 3.2% received ≥2 OCS courses and 5.8% regular OCS. Again in a minority of these patients (44.5%) a specialist prescribed the OCS. Extension of the evaluation to OCS prescriptions in the previous 3 yrs showed that 59% of these patients had a specialist OCS prescription. Conclusions: Our study showed that 7.1% of adults on asthma medication were exposed to frequent OCS courses or regular OCS in the focus yr. The majority of these patients received OCS without intervention of a specialist, suggesting that strategies to reduce the burden of OCS should be directed not only at specialists, but also at patients and non-specialists.