Table 2 Prescribing measures used in the analysis. Source and calculation from subsets.
Measure | Definition | Subsets for Calculation | Rationale | Reading | Source |
|---|---|---|---|---|---|
environmental inhalers (Environmental measure). | MDIs dispensed as a % of all MDIs/DPIs dispensed. | (mdi/mdi_dpi) * 100 | The NHS has committed to reducing its carbon footprint by 51% by 2025. DPIs emit less harmful greenhouse gas than traditional MDIs and the NHS long term plan supports the use of these inhalers where clinically appropriate. | Higher = ‘worse’. | |
ics laba lama combo pppm (’Severe’ asthma/COPD prescribing). | Number ICS/LABA/LAMA triple therapy inhaler prescriptions dispensed per asthma/COPD patient per month. | ics_laba_lama_combo/patients_resp_lsoa | ICS triple therapy is prescribed as regular maintenance for severe asthma and COPD. A relatively higher value between neighbourhoods would indicate greater prevalence of severe conditions compared to other severity levels. | Higher = ‘worse’. | |
ics laba pppm (’Moderate-Severe’ asthma/COPD prescribing). | Number ICS/LABA combination inhaler prescriptions dispensed per asthma/COPD patient per month. | ics_laba/patients_resp_lsoa | ICS/LABA combination inhalers are first line therapy for asthma, but only for COPD patients with high exacerbation risk. A relatively higher value between neighbourhoods would indicate greater prevalence of moderate-to-severe asthma cases compared to other severity levels. | Higher = ‘worse’. | |
ics pppm (’Mild-Moderate’ asthma prescribing). | Number ICS monotherapy inhaler prescriptions dispensed per asthma/COPD patient per month. | ics_mono/patients_resp_lsoa | ICS monotherapy inhalers are prescribed for mild-moderate asthma, but not recommended for COPD patients without asthma. A relatively higher value between neighbourhoods would indicate greater prevalence of mild-moderate asthma cases compared to other severity levels. | Lower = ‘worse’. | |
ics dose (High dose ICS). | Number ‘high dose’ ICS prescriptions dispensed as a % of all ICS-containing prescriptions. | (high_dose_ics_products/all_ics_products) * 100 | Greater potential risk of systemic side effects with high-dose ICS products. | Higher = ‘worse’. | |
laba ics (LABA/LAMA to ICS-containing prescriptions ratio). | Number of LABA/LAMA mono/combination inhaler prescriptions dispensed for each ICS-containing prescription. | laba_lama/all_ics_products | LABA/LAMA monotherapies are never recommended as sole treatment for asthma, but are first-line treatments for COPD. A higher value in this measure could therefore indicate inappropriate prescribing for asthma, or treatment optimisation for COPD. | Higher = ‘worse’ (asthma)/Higher = ‘better’ (COPD). | GP advisor. |
saba (Excess SABA prescribing). | SABA inhalers dispensed as a % of ICS and SABA inhalers. | (saba_inhaler_products/all_saba_ics_products) * 100 | High use of SABA and poor adherence in the use of ICS in asthma suggests poor control. These patients should be reviewed regularly to ensure good control. | Higher = ‘worse’. |
