Inhaled therapy recommended, but oral drugs still dominate asthma mkt

ICS prescribing rate remains around half overall… 38% in clinics

Lack of device education and service fee… structural reform needed

A significant gap between guidelines and clinical practice has been revealed in the field of asthma. Despite inhalers being recommended as the first-line standard therapy for asthma treatment, prescribing continues to focus on oral medications.

In particular, it has been pointed out that the failure to implement standard treatment in clinical practice has been exposed, with a lack of training on the use of inhalers and the absence of a corresponding reimbursement system identified as structural causes.

On the 15th, AstraZeneca Korea held a media session at its headquarters in Samseong-dong under the theme “Latest Insights on Asthma and Chronic Obstructive Pulmonary Disease (COPD) Treatment,” and shared the current status and challenges of respiratory disease treatment in Korea.

The company has a broad asthma and COPD treatment portfolio, including ‘Symbicort (budesonide/formoterol),’ ‘Fasenra (benralizumab),’ ‘Breztri (budesonide/glycopyrronium/formoterol),’ and ‘Tezspire (tezepelumab).’

However, even though a range of inhaled treatment options are available, including inhaled corticosteroids (ICS), long-acting beta2-agonists (LABA), and long-acting muscarinic antagonists (LAMA), actual prescribing patterns are diverging from guideline recommendations.

According to the Health Insurance Review and Assessment Service’s “2024 (11th) Asthma Care Quality Assessment,” the ICS prescribing rate, a key indicator in asthma treatment, was 51.9%, only 0.1 percentage point higher than the previous year’s 51.8%.

Jin-Kook Lee, Professor of Respiratory Medicine at Seoul St. Mary’s Hospital

The problem is that this gap widens as one moves down to primary care settings. The ICS prescription rate at clinics was 38.1%, significantly lower than the overall average, while the rate of prescribing oral corticosteroids (OCS) without ICS was 26.5%, the highest among provider types.

Although asthma treatment guidelines recommend inhaled medications as the first-line treatment for both disease-modifying and symptom-relieving agents, actual prescribing patterns do not adequately reflect this.

Prescription patterns by route of administration also support this trend. As of 2024, among patients receiving a single mode of administration, oral drugs accounted for the largest share at 42.0%, while inhaled therapies accounted for only 12.4%. Patches accounted for a mere 0.5%.

Among oral drugs, leukotriene receptor antagonists (LTRA) accounted for the highest share at 63.4%, while ICS remained the central component among inhaled therapies at 51.9%.

A lack of education on proper use of inhalers is identified as a key factor behind this bias toward oral medications.

Professor Jin-Kook Lee of the Department of Respiratory Medicine at Seoul St. Mary’s Hospital pointed out, “Although there are already enough treatments available for asthma and COPD, the reason they are not used effectively in practice is that inhaler-use education is not being delivered properly. With inhalers, proper technique determines treatment effectiveness, but there is not enough time or service fee incentives for institutions to provide education on this to patients.”

“Inhaler education requires at least 30 minutes, but the current clinical environment cannot accommodate this.  Unless fees or incentives for education are established, resolving this issue will not be easy.”

Although treatment options in severe asthma are expanding around biologics, limitations in access still remain. In reality, more than 90% of patients still experience difficulty in daily life, and the burden of side effects from long-term oral steroid use remains high.

The situation is not much different for COPD. While it is estimated that approximately 13% of the domestic population aged 40 and older has the condition, the actual diagnosis rate is only 2.8%, and the treatment rate is a mere 1.6%.

To address these issues, the government introduced pulmonary function testing into the national health screening program starting this year. However, there are concerns that the effect may remain limited unless a management system is built to ensure that early diagnosis actually leads to treatment.

Ultimately, structural improvements are needed across the entire “diagnosis-treatment-management” process for both asthma and COPD. In particular, establishing education and reimbursement systems to ensure the adoption of inhaler-based standard therapy in actual practice has emerged as a core task.

Professor Lee emphasized, “Inhalers are the foundation and standard of treatment for asthma and COPD, but the current system makes it difficult to use them properly. Since oral medications cannot replace inhalers, we must establish both an educational system that extends to primary care facilities and a corresponding fee system that supports it.”