37% of asthma patients in the UK are now finding it harder to afford the medicines they need than before the recession, and they are making “dangerous” decisions to stretch or skip doses of their inhaled medicines because they cannot afford to pay for them, new studies show.

Moreover, three-quarters of the over 73,000 asthma-related emergency admissions to UK hospitals each year could be avoided if the condition was better controlled, potentially saving the economy around £46 million, according to the leading charity Asthma UK, which conducted one of the studies.

Patients can make significant savings on their medications through the use of prescription Pre-Payment Certificates (PPCs), but the survey revealed that one-third of people with asthma were not aware of this fact.

Official figures published in January 2009 for the first six months of the Scottish government’s policy of reducing prescription charges, ahead of their total abolition in 2011, showed an increase in the number of PPCs being purchased and a 25.9% rise in the quantity of drugs dispensed using them, which suggests that people with long-term conditions may now be buying medicines they avoided taking before, says the charity.
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Asthma UK is one of a coalition of 19 charities which launched the “Prescription Promise” campaign on April 1, calling on the government to honour the pledge it made last year to abolish prescription charges for people with long-term conditions, and to do so before the next General Election. A review of how to implement this promise was due to report over the summer, but this has been delayed until the third quarter of the year.

“We know that people with asthma who don’t take their preventer medicines as prescribed are more likely to end up in hospital and that three-quarters of hospital admissions for asthma could be avoided through better asthma management,” said Neil Churchill, chief executive of Asthma UK.

The charity’s chief medical advisor, GP Dr Mike Thomas, added that he knew of "numerous cases" where people have stretched or stopped using their preventer medicines to try to reduce prescription charge costs, often because they notice the immediate effects of relievers more than the potent long-term effects of their preventers.

_“It seems illogical that people with some long-term conditions, like thyroid disease, receive free prescriptions, while those with conditions like asthma do not. Unfortunately, there isn’t much that GPs can do other than increase the number of inhalers on a prescription, which can encourage waste and is discouraged by Primary Care Trusts,” said Dr Thomas.

Keeping costs down
The other study examined the effects of prescription charges on how asthma patients in England manage their condition. It found that many patients did not believe they should have to pay charges for their asthma treatments, and that others used a range of strategies to keep the costs for down, including prioritizing types of treatment, rationing, substituting and postponing, plus making trade-offs with other needs.

However, despite their difficulties, these patients did not generally raise the issues of prescription charge costs or affordability with their GPs, who may be willing and able to help, and it may therefore be useful for GPs and other healthcare professionals to include questions relating to costs and affordability in their consultations and medicine use reviews, suggests the study author, Ellen Schafheutle of Manchester University’s school of pharmacy and pharmaceutical sciences.

Dr Schafheutle’s study, which is reported in the Primary Care Respiratory Journal (PCRJ). found that awareness of PPCs was not an issue among the patients she interviewed, but not all who would have benefited from the scheme were using it. Some, particularly those on low incomes, could not afford the lump-sum payments of £27.85 for three months’ treatment or £102.50 to cover 12 months’ medication, and while a monthly direct debit payment facility has now been introduced for the 12-month PPC, the scheme may be failing patients with episodic conditions, because they need to be able to predict their medication use for advance purchase, she says.