Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

Baddar, Sawsan; Jayakrishnan, B; Al-Rawas, Omar A; George, Jojy; Al-Zeedy, Khalfan

doi:10.12816/0003197

Cited by 8 publications

(6 citation statements)

References 23 publications

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“…Other potential explanations for this observation are the fact that most asthma guidelines are generally biased toward a secondary care perspective, thereby limiting their implementation in a primary care setting; unfamiliarity of primary care clinicians with GINA recommendations [ 35 ]; and a time lag between revisions to GINA and subsequent updates of local guidelines. Notably, SABA over-prescription was more common in patients with mild asthma; in line with previous reports in the literature, this may be due to the potential underestimation of patients with milder disease [ 37 – 39 ], resulting in inappropriate management of patients with mild asthma, leading to poor symptom control. However, discrepancies between clinical and objective assessments of asthma may also have led to a misclassification of asthma severity [ 40 ], resulting in a proportion of patients with moderate-to-severe asthma not being adequately captured.…”

Section: Discussionsupporting

confidence: 77%

Over-prescription of short-acting β2-agonists remains a serious health concern in Kenya: results from the SABINA III study

2023

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Background Despite a high asthma burden in Kenya, insights into asthma management practices, including prescription of short-acting β2-agonists (SABAs), are lacking. Therefore, this study describes patient demographics, disease characteristics, and asthma treatment patterns in the Kenyan cohort of the SABA use IN Asthma (SABINA) III study. Methods Patients with asthma (aged ≥ 12 years) with medical records containing data for ≥ 12 months prior to the study visit from 19 sites across Kenya were included in this cross-sectional study and classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA] recommendations) and practice type (primary/specialist care). Data on severe exacerbation history, prescribed asthma treatments, and over-the-counter (OTC) SABA purchases in the 12 months before the study visit and asthma symptom control at the time of the study visit were collated using electronic case report forms. All analyses were descriptive in nature. Results Overall, 405 patients were analyzed (mean age, 44.4 years; female, 68.9%), of whom 54.8% and 45.2% were enrolled by primary care clinicians and specialists, respectively. Most patients were classified with mild asthma (76.0%, GINA treatment steps 1−2) and were overweight or obese (57.0%). Only 19.5% of patients reported full healthcare reimbursement, with 59% receiving no healthcare reimbursement. The mean asthma duration of patients was 13.5 years. Asthma was partly controlled/uncontrolled in 78.0% of patients, with 61.5% experiencing ≥ 1 severe exacerbation in the preceding 12 months. Crucially, 71.9% of patients were prescribed ≥ 3 SABA canisters, defined as over-prescription; 34.8% were prescribed ≥ 10 SABA canisters. Additionally, 38.8% of patients purchased SABA OTC, of whom 66.2% purchased ≥ 3 SABA canisters. Among patients with both SABA purchases and prescriptions, 95.5% and 57.1% had prescriptions for ≥ 3 and ≥ 10 SABA canisters, respectively. Inhaled corticosteroids (ICS), ICS with a long-acting β2-agonist fixed-dose combination, and oral corticosteroid bursts were prescribed to 58.8%, 24.7%, and 22.7% of patients, respectively. Conclusions SABA over-prescription occurred in almost three-quarters of patients, with over one-third of patients purchasing SABA OTC. Therefore, SABA over-prescription is a major public health concern in Kenya, underscoring an urgent need to align clinical practices with latest evidence-based recommendations.

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Section: Discussionsupporting

confidence: 77%

Over-prescription of short-acting β2-agonists remains a serious health concern in Kenya: results from the SABINA III study

2023

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“…Our findings revealed that 57.2% of patients with mild disease reported having uncontrolled/partly controlled asthma, potentially due to inadequate treatment, and suggestive of under-recognition of both disease control and underlying asthma severity. Indeed, both PCPs 33,37,38 and patients 5 tend to overestimate the level of asthma control, leading to under-treatment of the disease 37 . Moreover, patients often perceive control as symptom relief and/or management of exacerbations, reflective of crisis-oriented disease management 39 , which may further contribute to SABA over-reliance.…”

Section: Discussionmentioning

confidence: 99%

“…npj Primary Care Respiratory Medicine (2022)37 Published in partnership with Primary Care Respiratory Society UK…”

mentioning

confidence: 99%

Short-acting β2-agonist prescription patterns for asthma management in the SABINA III primary care cohort

Price

Hancock²,

Doan³

et al. 2022

npj Prim. Care Respir. Med.

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Short-acting β2-agonist (SABA) prescriptions and associated outcomes were assessed in 1440 patients with asthma from the SABA use IN Asthma (SABINA) III study treated in primary care. Data on asthma medications were collected, and multivariable regression models analysed the association of SABA prescriptions with clinical outcomes. Patients (mean age, 47.9 years) were mostly female (68.6%); 58.3% had uncontrolled/partly controlled asthma and 38.8% experienced ≥1 severe exacerbation (reported in 39% of patients with mild asthma). Overall, 44.9% of patients were prescribed ≥3 SABA canisters (over-prescription) and 21.5% purchased SABA over-the-counter. Higher SABA prescriptions (vs 1−2 canisters) were associated with significantly decreased odds of having at least partly controlled asthma (6–9 and 10–12 canisters) and an increased incidence rate of severe exacerbations (10–12 and ≥13 canisters). Findings revealed a high disease burden, even in patients with ‘mild’ asthma, emphasising the need for local primary care guidelines based on international recommendations.

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“…Indeed, PCPs tend to overestimate asthma control, leading to undertreatment of asthma. [22][23][24] Moreover, many patients, including those with mild asthma, overestimate their level of asthma control, [17,25] resulting in sporadic use of maintenance therapy [26] and over-reliance on SABA alone for rapid symptom relief during episodes of asthma worsening. [27] In addition, many patients perceive control as the management of exacerbations, reflective of a crisis-oriented mindset.…”

Section: Discussionmentioning

confidence: 99%

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study

Smith¹,

Ambaram²,

Mitha³

et al. 2022

Afr J Thoracic Crit Care Med

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Background. Asthma medication prescription trends, including those of short-acting β2-agonists (SABAs), are not well documented for South Africa (SA).Objectives. To describe demographics, disease characteristics and asthma prescription patterns in the SA cohort of the SABA use IN Asthma (SABINA) III study. Methods. An observational, cross-sectional study conducted at 12 sites across SA. Patients with asthma (aged ≥12 years) were classified by investigator-defined asthma severity, guided by the Global Initiative for Asthma (GINA) 2017 recommendations, and practice type (primary/ specialist care). Data were collected using electronic case report forms.Results. Overall, 501 patients were analysed − mean (standard deviation) age, 48.4 (16.6) years; 68.3% female − of whom 70.6% and 29.4% were enrolled by primary care physicians and specialists, respectively. Most patients were classified with moderate-to-severe asthma (55.7%; GINA treatment steps 3 - 5), were overweight or obese (70.7%) and reported full healthcare reimbursement (55.5%). Asthma was partly controlled/uncontrolled in 60.3% of patients, with 46.1% experiencing ≥1 severe exacerbations in the 12 months before the study visit. Overall, 74.9% of patients were prescribed ≥3 SABA canisters in the previous 12 months (over-prescription); 56.5% were prescribed ≥10 SABA canisters. Additionally, 27.1% of patients reported purchasing SABA over-the-counter (OTC); among patients with both SABA purchase and prescriptions, 75.4% and 51.5% already received prescriptions for ≥3 and ≥10 SABA canisters, respectively, in the preceding 12 months. Conclusion. SABA over-prescription and OTC purchase were common in SA, demonstrating an urgent need to align clinical practices with the latest evidence-based recommendations and regulate SABA OTC purchase to improve asthma outcomes.

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Is Clinical Judgment of Asthma Control Adequate ? : A Prospective Survey in a Tertiary Hospital Pulmonary Clinic = هل يكفي الحكم السريري لتقدير مدى السيطرة على مرض الربو ؟

Cited by 8 publications

References 23 publications

Over-prescription of short-acting β2-agonists remains a serious health concern in Kenya: results from the SABINA III study

Over-prescription of short-acting β2-agonists remains a serious health concern in Kenya: results from the SABINA III study

Short-acting β2-agonist prescription patterns for asthma management in the SABINA III primary care cohort

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study

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