Trends in initial pharmacological treatment of asthma in primary care (2010-2021): A population-based study using the PHARMO data network

INTRODUCTION: Real-world evidence of asthma management in primary care is limited but of paramount importance for improving care quality. This study described the trends of initial pharmacological treatments prescribed by Dutch general practitioners (GPs) from 2010-2021. METHODS: This was a repeated cross-sectional study of adults with asthma using the PHARMO data network. Initial treatments were defined based on the first prescription within 90 days of diagnosis. Trends were analysed using joinpoint regression and compared across age groups and between sexes. RESULTS: 95,523 adults with asthma were included (39.9% male; median age 45 [31, 59] years). SABA without ICS increased until 2018 from 17.0% to 29.5% and then decreased to 26.1% by 2021. In contrast, ICS-LABA decreased from 25.1% to 22.1% until 2018, increasing subsequently to 30.6% in 2021. ICS without LABA remained unchanged until 2013. Between 2013 and 2019, it increased from 13.8% to 15.8%, followed by a decline to 11.2%. Triple therapy was consistently around 1%. Patients without prescriptions for asthma decreased over the study period (34.2% to 25%). SABA without ICS was more prescribed to young adults than middle-aged adults and the elderly, whereas the opposite was found for ICS-LABA and ICS-LABA-LAMA in both sexes (all adjusted-p<0.05). CONCLUSION: The observed changes in initial treatment of asthma in Dutch primary care seem to reflect the updating of recommendations, however, many patients were on SABA without ICS or did not receive a prescription from their GP, emphasising the need for strategies to improve asthma care. Age-related differences warrant further investigation.