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

Abstract

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.

The Association Between Short-Acting β2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia

“…In agreement with previous studies we found a link between SABA over-prescription and poor asthma outcomes [ 4 – 6 , 18 ], with SABA overuse likely the result of chronic poor asthma control rather than its cause. Assessment of SABA use represents an important tool for measuring the success of asthma management, informing treatment modification decisions [ 19 ], may encourage physicians and pharmacists to more carefully consider SABA prescription and recommendation practices, and prompt investigations of asthma control, adherence and inhaler technique.…”

Over-the-counter use of short-acting beta-2 agonists: a systematic review

“…However, among those with mild asthma, 7% purchased ≥ 6 SABA canisters per year, which was a slightly higher percentage than those with moderate/severe asthma, of whom only 5% purchased six or more canisters annually. Of those who acquired SABA over-the-counter, 91% already received SABA prescriptions and 59% received prescriptions for three or more SABA canisters in the past year Not stated [ 44 ] Price et al 24 countries which include Russia, Australia, South Africa, Kenya, Egypt, Turkey, Saudi Arabia, the United Arab Emirates, Kuwait, Oman, Mexico, Costa Rica, Columbia, Chile, Brazil, Argentina, Thailand, Taiwan, South Korea, Singapore, Philippines, Malaysia, Indonesia, and India A multi-country, cross-sectional observational study (SABINA III sub-analysis study) Not stated Study targets: patients with asthma, aged 12 years or older, who had undergone at least three consultations with healthcare professionals, had medical records with at least 12 months of data prior to the study visit, and no other chronic respiratory disease other than asthma were recruited by primary care physicians and specialists from 24 countries across five continents. Number of participants: a total of 8351 participants were included in this study Used ≥ 3 SABA canisters per year 21.5% (12 months prior to the study visit) Not stated Mild asthma patients preferred to purchase SABA over-the-counter than moderate-to-severe asthma (24.1% vs 18.4%).…”

“…The studies reviewed revealed varying preferences for over-the-counter SABA purchases among patients with both moderate-to-severe and mild asthma [ 38 , 39 , 43 , 44 ]. One-third of patients in Turkey (29.4%) and two-thirds of patients in Saudi Arabia (69.3%) preferred to purchase SABA without a prescription while having moderate-to-severe asthma [ 38 , 39 ].…”

“…In the same studies, in contrast, only 12.5% and 33.3% of patients with mild asthma in Turkey and Saudi Arabia, respectively, made over-the-counter purchases [ 38 , 39 ]. Conversely, two other studies reported that mild asthma patients were more likely to purchase over-the-counter SABA (7% and 24.1% in these studies) compared to those with moderate-to-severe asthma (5% and 18.4%) [ 43 , 44 ]. Further, most of the studies reviewed indicated that most over-the-counter SABA users also had SABA prescriptions, that 29.4% to 80.4% had received three or more SABA prescriptions and 13.5% to 56.7% had been prescribed with 10 or more SABA canisters in the past one year [ 35 , 37 – 39 , 42 , 44 ].…”

Effect of Individual Patient Characteristics and Treatment Choices on Reliever Medication Use in Moderate-Severe Asthma: A Poisson Analysis of Randomised Clinical Trials

“…Unfortunately, longitudinal data describing reliever use at individual patient level are scarce, and cross-sectional studies do not overcome this shortcoming. Consequently, there is limited insight into how the interplay among patient-, disease- and treatment-related factors affects the natural history of asthma control [ 14 ]. Instead, most reports focus primarily on the history of prior exacerbations, as asthma exacerbations are known to affect airway function and the clinical course of asthma symptoms [ 15 ].…”