Is higher population‐level use of ICS ICS / LABA LABA combination associated with better asthma outcomes? C C ross‐sectional surveys of nationally representative populations in N N ew Z Z ealand and A A ustralia

摘要

ABSTRACT Background and objective New Zealand ( NZ ) and Australia ( AU ) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma‐related outcomes between these countries. Methods A web‐based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16?years with current asthma, drawn randomly from web‐based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test ( ACT ). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. Results NZ ( n ?=?537) and Australian ( n ?=?2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid ( ICS )‐containing medication (68.8% vs 60.9%; P ?=?0.006) but ICS /long‐acting β 2 ‐agonist ( LABA ) constituted 44.4% of NZ and 81.5% of Australian total ICS use ( P ??0.0001). Adherence was higher with ICS / LABA than ICS ‐alone ( P ??0.0001), and higher in NZ than in AU ( P ??0.0001). ACT scores were similar ( P ?=?0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non‐urgent asthma reviews (56.6% vs 50.4%; P ?=?0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P ?=?0.75). Conclusion This comparison, which included the first nationally representative data for asthma control in NZ , showed that poorly controlled asthma is common in both NZ and AU , despite subsidized ICS ‐containing medications. The greater use of ICS ‐alone in NZ relative to ICS / LABA does not appear to have compromised population‐level asthma outcomes, perhaps due to better adherence in NZ . Different ICS / LABA subsidy criteria and different patient copayments may also have contributed to these findings.