Trends in prescribing inhaled corticosteroids alone and in combination with long-acting β2-agonists in Europe in 2004–2009

Background: Prescription of inhaled corticosteroids (ICSs) alone and in free or fixed combination with long-acting β₂-agonists (LABAs) is widely accepted as part of a stepped approach to the management of asthma. The aim of this study was to characterize trends in the prescribing of ICSs, whether given as a monotherapy, or concurrently with a LABA in a free or fixed-dose combination (FDC), in Europe between 2004 and 2009.

Methods: Data on the retail prescription of ICSs and LABAs in 12 European countries (Austria, Denmark, Finland, France, Germany, Ireland, Italy, Netherlands, Spain, Sweden, Switzerland and UK) was obtained by year quarter (Q) between Q4 2004 and Q3 2009 from the MIDAS database (IMS Health, London, UK). For each each treatment, the number of actuations was converted to the number of inhalers prescribed.

Results: Prescribing of ICSs alone or as a free combination declined by 3.0% from 57,322 inhalers in Q4 2004–Q3 2005 to 55,627 inhalers in Q4 2008–Q3 2009. Over the same period, prescribing of ICS/LABA FDCs rose steadily by 47.5% from 41,061 inhalers to 60,552 inhalers. The biggest relative increases were seen in the UK (80.7%), Ireland (69.0%), Denmark (51.8%), Italy (51.4%) and Germany (51.2%). The most frequently prescribed ICSs in the most recent period studied (Q4 2008 to Q3 2009) were fluticasone (44,451 inhalers, 38.3%), budesonide (37,780 inhalers, 32.5%) and beclometasone (33,950 inhalers, 29.2%).

Conclusion: We observed an increasing trend in the prescribing of ICS/LABA FDCs over the period 2004–2009, whereas prescribing of ICSs alone or in free combinations with a LABA declined over the same period. As a consequence, ICS/LABA FDCs account for the majority of ICSs prescribed in Europe.