Long-acting β2 agonist without concomitant inhaled corticosteroids in children with asthma in primary care

(Inter)national asthma guidelines discourage the use of long-acting beta2 agonists (LABAs) without concomitant inhaled corticosteroids (ICS). The extent to which LABA monotherapy actually occurs is uncertain. Objectives :To evaluate prescription patterns of LABA without ICS(=LABAmono) and LABA with ICS(in 1 inhaler=LABAfx or in 2 separate=LABAapart) in children with asthma. Additionally, to identify risk factors associated with LABAmono. Methods :Population based cohort study using the IPCI database, a Dutch primary care database containing complete medical records of >1 million patients. All children with physician diagnosed asthma, aged 5-18 years between 2000-2012, were identified and validated. The annual prevalence was calculated per 100 patient years(PY), stratified by age and gender. Results :The asthma cohort consisted of 14,304 children with 35,118 PY of follow-up. The overall annual prevalence were LABAtotal 27.8/100PY, LABAfx 24.3/100PY, LABAapart 2.9/100PY and LABAmono 1.8/100PY. LABA prescribing increased with age, and was higher in girls compared to boys after the age of 13 years. LABAmono and LABAapart decreased with time with prevalences of 1.44/100PY and 1.52/100PY in 2011. Children receiving LABAmono were older at first LABA prescription, and had a lower severe exacerbation rate compared to LABAapart, suggesting less severe asthma. In LABAapart, LABA exposed days were covered with ICS in almost 100%(IQR(91.9-100). Conclusions :In Dutch pediatric primary care, LABA prescribing as a separate inhaler has declined, but still occurs in a small percentage. Despite (inter)national guidelines, prescription of LABAmono continues to occur in children with asthma.