Report of the social insurance committee: survey on outpatient treatment management and guidance for inhalation therapy in infants and toddlers with bronchial asthma

Abstract

[Objective] This study aimed to clarify the conditions for inhalation guidance and medical reimbursement in outpatient care for infants and toddlers with asthma.

[Methods] We conducted a web survey targeting 4,018 members of the Japanese Society of Pediatric Allergy and Clinical Immunology who had registered their email addresses.

[Results] Among the 688 respondents (response rate: 17%), 675 (93%) reported providing instruction on the use of a spacer when prescribing inhaled corticosteroids. Physicians were the most common providers of inhalation guidance 514 (84%), followed by pharmacists in external pharmacies 198 (32%). Regarding the reimbursement for asthma management (280 points for Asthma Guidance and Management Fee 2; AGMF2), the cost of spacers borne by medical institutions was most commonly from JPY 2,501-3,000 86 (36%). Upon the initial guidance, the cost of the spacer was borne by patients in 321 (53%), followed by 181 (30%) covered under AGMF2. However, for subsequent spacer costs, the patient burden increased to 482 (82%). Ideally, 268 (46%) of the respondents indicated that spacers should be replaced annually. However, in practice, 385 (65%) replaced them only if they became unusable.

[Conclusion] Physicians primarily provided inhalation guidance. Approximately 50% of the patients borne the initial spacer cost, and the AGMF2 was insufficient to cover the spacer cost, with only one-third using it.