The Pharmaceutical Benefits Advisory Committee has rejected moves to change PBS restrictions on fixed dose combination LABA/ICS inhalers for children to “authority streamlined”.

In a response to the Department of Health’s review of PBS Medicines Used to Treat Asthma in Children the PBAC said that while it accepted the findings of the review that there was minimal evidence to support the use of combination inhalers over ICS alone in children with persistent asthma it did not agree with the main recommendation to restrict their use.

The change would be difficult to implement as there was inconsistency between ages specified in product information and recommendations in clinical guidelines for some of these medicines, the PBAC said in its response.

It agreed with views from stakeholders that some prescribers may not be aware they were prescribing outside the guidelines and PBS restrictions.

Audit processes that alert prescribers to current asthma management guidelines and PBS restrictions could be an effective means of raising awareness and changing prescriber behaviour where it is most needed, they said.

Key PBAC advice to the Minister for Health:

• Fixed dose combination LABA/ICS inhalers should not be changed to an Authority Required (streamlined) restriction.
• Remove the requirement to stabilise children under 12 on separate ICS and LABA inhalers prior to initiating Seretide® in line with National Asthma Council guidelines.
• Minimum age requirement of 4 for fluticasone propionate/salmeterol xinafoate (Seretide®)
• Software alerts should be implemented to warn prescribers of age restrictions.
• More NPS MedicineWise educational programs that target quality use of medicines in children with asthma.
• More research into patient relevant outcomes and safety of ICS/LABA step up compared with other step up options including ICS/montelukast.

To read the full PBAC report click here.