Trends in medication use for asthma in school-entry children in the Australian Capital Territory, 2000–2005

Christine B Phillips, Helen Toyne, Karen Ciszek, Robyn G Attewell and Marjan Kljakovic
Med J Aust 2007; 187 (1): 10-13.


Objective: To analyse trends in asthma medications used by school-entry children whose parents report they have asthma.

Design and setting: Annual cross-sectional study of all school-entry children (about 4400 each year) in the Australian Capital Territory in 2000–2005, by means of a questionnaire for parents on child health status and medication use; and a cross-sectional study of asthma prescriptions for children aged 5 years obtained from the Medicare Australia database for 2002–2005.

Participants: All school-entry children in the ACT with parent-reported asthma (numbers in the years 2000–2005 ranged between 435 and 589).

Main outcome measures: Changes in the use of different medications; changes in delivery devices for asthma; changes in the potency of inhaled fluticasone.

Results: Response rates to kindergarten health screening were in the range 85%–89% for 2000–2005. Parent-reported asthma prevalence ranged from 11% to 15%. Each year, around 35% of children with asthma (age range, 4–6 years) used inhaled corticosteroids. An increase in the use of fluticasone (from 11% to 33% of children with asthma) was offset by decreases in beclomethasone use (from 14% to 3%) and budesonide (from 14% to 4%). Use of cromoglycate and nedocromil fell from 46% to 16%. Nebuliser use decreased (from 45% to 20%), while the use of spacer devices increased (from 70% to 83%). Use of combined salmeterol/fluticasone increased from 8% (in 2002) to 20% (in 2005) of children with parent-reported asthma. These trends were mirrored in Medicare Australia data for 5-year-old children in the ACT.

Conclusions: There was marked volatility in the types of asthma medication used over the 6 years. Reciprocal trends leading to increased use of spacers and decreased use of nebulisers are in accord with national guidelines for better asthma management. The increasing use of products containing a combination of salmeterol and fluticasone requires ongoing monitoring.

  • Christine B Phillips1
  • Helen Toyne1
  • Karen Ciszek1
  • Robyn G Attewell2
  • Marjan Kljakovic1

  • 1 Academic Unit of General Practice and Community Health, Australian National University, Canberra, ACT.
  • 2 Covance Pty Ltd, Canberra, ACT.


We are grateful to the maternal and child nurses from ACT Health who undertook the kindergarten health screening, Dr Clare McGuiness for advice, and Ms Maxine Robinson and staff of the Drug Utilisation Sub-Committee of the Pharmaceutical Benefits Advisory Committee, Australian Government Department of Health and Ageing for assistance with accessing Medicare Australia data.

Competing interests:

Covance Pty Ltd has ongoing consulting agreements with Boehringer Ingelheim, AstraZeneca and GlaxoSmithKline Australia. Robyn Attewell has been involved in research in primary care and clinical settings under these contracts. Her contribution to this article was not related to these contracts, and was under a separate consulting contract with ACT Health and Community Care.

  • 1. Australian Institute of Health and Welfare Australian Centre for Asthma Monitoring. Asthma in Australia 2005. AIHW Asthma series No. 2. Canberra: AIHW, 2005. (AIHW Cat. No. ACM 6.) (accessed May 2007).
  • 2. Johansson M, Hall J, Reith D, et al. Trends in the use of inhaled corticosteroids for childhood asthma in New Zealand. Eur J Clin Pharmacol 2003; 59: 483-487.
  • 3. Boyter AC, Steinke DT. Changes in prescribing of inhaled corticosteroids (1999–2002) in Scotland. Pharmacoepidemiol Drug Saf 2005; 14: 203-209.
  • 4. Robertson J, Fryer JL, O’Connell DL, et al. Limitations of Health Insurance Commission (HIC) data for deriving prescribing indicators. Med J Aust 2002; 176: 419-424. <MJA full text>
  • 5. Britt H, Miller GC, Knox S, et al. General practice activity in Australia 2004–05. General Practice Series No. 18. Canberra: Australian Institute of Health and Welfare, 2005. (AIHW Cat. No. GEP 18.) (accessed Jun 2007).
  • 6. Mommers M, Swaen GM, Weishoff-Houben M, et al. Differences in asthma diagnosis and medication use in children living in Germany and the Netherlands. Prim Care Respir J 2005; 14: 31-37.
  • 7. Phillips CB, Yates R, Glasgow NJ, et al. Improving response rates to primary and supplementary questionnaires by changing response and instruction burden: cluster randomised trial. Aust N Z J Public Health 2005; 29: 457-460.
  • 8. Ellwood P, Asher MI, Beasley R, on behalf of the International Study of Asthma and Allergies in Childhood Steering Committee and the ISAAC Phase Three Study Group. ISAAC phase three manual. Auckland: ISAAC, 2000. (accessed May 2007).
  • 9. Australian Bureau of Statistics. Population by age and sex, Australian states and territories, 2006. Canberra: ABS, 2006. (ABS Cat. No. 3201.0.) OpenDocument (accessed May 2007).
  • 10. World Health Organization Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment. Oslo: WHOCC for Drug Statistics Methodology, January 2006.
  • 11. Van der Wouden JC, Tasche MJA, Bernsen RMD, et al. Sodium cromoglycate for asthma in children. Cochrane Database Syst Rev 2003; (3): CD002173. DOI: 10.1002/14651858.CD002173 (accessed Jun 2007).
  • 12. Pedersen S. Clinical safety of inhaled corticosteroids for asthma in children: an update of long-term trials. Drug Saf 2006; 29: 599-612.
  • 13. Ferguson AC, Van Bever HP, Teper AM, et al. A comparison of the relative growth velocities with budesonide and fluticasone propionate in children with asthma. Respir Med 2007; 101: 118-129.
  • 14. Asthma management handbook 2006. Melbourne: National Asthma Council Australia, 2006. (accessed May 2007).
  • 15. Bisgaard H, Le Roux P, Bjamer D, et al. Budesonide/formoterol maintenance plus reliever therapy: a new strategy in pediatric asthma. Chest 2006; 130: 1733-1744.
  • 16. Nelson HS, Weiss SC, Bleecker ER, et al; SMART Study Group. The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 2006; 129: 15-26. [Erratum: Chest 2006; 129: 1393.]
  • 17. Janson C, de Marco R, Accordini S, et al. Changes in the use of anti-asthmatic medication in an international cohort. Eur Respir J 2005; 26: 1047-1055.
  • 18. Martinez FD. Safety of long-acting beta-agonists — an urgent need to clear the air. N Engl J Med 2005; 353: 2637-2639.


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