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From 1 February, 2012 schedule changes for some asthma medicines may influence prescribing practices - particularly for patients taking long-acting beta-2 agonists (LABA).

Schedule change details

  • There is no longer a requirement for patients to take a separate inhaled corticosteroid (ICS) and LABA for three months prior to being eligible for fully subsidised combination inhalers
  • Fluticasone powder for inhalation (Flixotide Accuhaler) is now fully subsidised
  • Salmeterol (Serevent, Serevent Accuhaler) will become the only fully subsidised stand-alone LABA. A surcharge will apply to stand-alone eformoterol inhalers (Oxis Turbuhaler, Foradil).

Changes to Special Authority for combination inhalers

The Special Authority changes for combination ICS and LABA inhalers now means that two year approval will be granted to patients who are likely to receive additional benefit from a combination inhaler, following treatment with an ICS (at least 800 mcg/day beclomethasone or budesonide, or 500 mcg/day fluticasone, and at least 400 mcg/day beclomethasone or budesonide, or 200 mcg/day fluticasone for children aged < 12 years).

Previously, a three month period of treatment with separate LABA and ICS inhalers was required before a combination inhaler could be prescribed. Easing the restrictions on combination ICS and LABA inhalers means it is now easier for patients to comply with recommendations that a LABA always be taken in conjunction with an ICS. LABA may increase the risk of asthma related deaths, particularly amongst children, however, concurrent use of ICS appears to reduce this effect.1

Combination ICS/LABA inhalers containing budesonide with eformoterol (Vannair, Symbicort Turbuhaler) and fluticasone with salmeterol (Seretide, Seretide Accuhaler) are all now fully funded.

All inhaled corticosteroids (ICS) are now fully subsidised

Fluticasone 50, 100 and 250 mcg as a powder for inhalation (Flixotide Accuhaler) is now fully funded along with all other available individual ICS inhaler devices: beclomethasone aerosol (Beclazone), fluticasone aerosol (Flixotide) and budesonide powder (Pulmicort Turbuhaler, Budenocort).

Stand-alone eformoterol inhalers now subject to a part-charge

From 1 February 2012, a part-charge will apply to the Oxis Turbuhalers and Foradil inhalers containing eformoterol fumarate (a LABA). However, repeat dispensings for prescriptions where the first dispensing was before 1 February, 2012 will be fully funded.

If a fully subsidised stand-alone LABA is required patients can be safely switched to salmeterol (Table 1).

Table 1: Salmeterol versus eformoterol2
LABA Onset of action Time to peak effect Duration Dose
Salmeterol 10-30 minutes 3-4 hours >12 hours 50 mcg twice daily, maximum 100 mcg twice daily
Eformoterol 1-3 minutes 1-2 hours >12 hours

6-12 mcg once or twice daily, maximum 24 mcg twice daily

Additional doses may be given for short-term symptom relief up to a maximum daily dose of 72 mcg

For further information on asthma see: “Diagnosing and managing asthma in children”, “Guide to asthma management in children”, BPJ, Special Edition (May, 2009).

References

  1. McMahon AW, Levenson MS, McEvoy BW, et al. Age and risks of FDA-approved long-acting b2-adrenergic receptor agonists. Pediatrics 2011;128(5);e1147-54.
  2. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2011.