Real-world prescribing patterns of inhaled corticosteroid-containing inhalers following acute respiratory tract infections: A nationwide claims database study.

BACKGROUND

Inhaled corticosteroid (ICS)-containing inhalers are not routinely recommended for acute cough following respiratory tract infections in patients without chronic respiratory diseases; however, they are sometimes prescribed for acute cough. This study aimed to characterize real-world patterns of inhaled therapy initiation following respiratory tract infections.

METHODS

This retrospective descriptive study utilized an administrative claims database in Japan. We identified adult outpatients without chronic respiratory diseases, who were diagnosed with acute upper or lower respiratory tract infections between 2006 and 2022, and enrolled those who received an ICS-containing inhaler within 21 days of the diagnosis. We assessed treatment patterns, diagnostic examinations (imaging, blood tests, and pulmonary function testing), and medication costs. Potentially inappropriate prescription was defined as inhaler initiation without diagnostic examinations from the respiratory tract infection diagnosis to 30 days after initiation, with no re-prescription within 90 days.

RESULTS

Among 4,640,282 eligible patients, 267,887 (5.8%) received an ICS-containing inhaler. The median time to initiation was 1 day; most prescriptions were issued on the day of diagnosis. Pulmonary function testing was performed in 16.7% of patients. The proportion of re-prescription within 90 days was 26.0%. Overall, 40.3% met the definition of potentially inappropriate prescription. In these patients, the median cost of ICS-containing inhalers was USD 20.0, representing 59.3% of the total medication expenditure for respiratory tract infections.

CONCLUSIONS

ICS-containing inhalers were sometimes prescribed as one-time treatments following respiratory tract infections without objective evaluation, reflecting short-term empirical use rather than maintenance therapy and potentially contributing to inefficient healthcare resource utilization.