Overuse of asthma rescue inhalers common, varies among practices

Rates of overprescribing of short-acting beta agonist asthma inhalers remain high and vary significantly among practices, according to new data published in the British Journal of General Practice.

Researchers conducted a cross-sectional study to quantify the prevalence of SABA overprescribing and identify predictors that lead to overprescribing. The researchers evaluated 30,694 primary care medical records in February 2020 for patients with asthma aged 5 to 80 years from 117 practices in east London.

Twenty-six percent of patients with asthma were prescribed six or more SABA inhalers in the prior year.

The researchers reported a 10-fold variation in prescription of SABA inhalers between the different practices, ranging from 6% to 60% in the proportion of patients on at six or more SABA inhalers per year, according to the results.

When SABA and inhaled corticosteroids (ICS) were converted to standard units, researchers observed an improvement in comparison accuracies across different preparations, with 25% of patients with using six or more SABAs per year underusing ICS. This proportion increased to 80% for patients prescribed six or more SABA inhalers per year, according to the results.

Age older than 60 years (OR = 1.34; 95% CI, 1.24-1.45) and presence of four or more physical and mental comorbidities (OR = 1.86; 95% CI, 1.61-2.13) were associated with higher risk for SABA overprescription.

In addition, prescription modality strongly predicted SABA overprescription, as repeat dispensing was strongly associated with overprescribing SABAs (OR = 6.52; 95% CI, 4.64-9.41), the researchers wrote. Other independent predictors for SABA overprescription were increasing asthma severity and multimorbidity.

“Working with patients to improve regular use of preventative inhalers should be central to reducing asthma-related hospital admissions. There is still significant room for improvement - we calculated that supporting patients who use more than 12 SABA inhalers per year to reduce their use to 4 to 12 could result in 70% fewer asthma-related hospital admissions in that group,” Anna De Simoni, MBBS, PhD, clinical lecturer in digital health at the Wolfson Institute of Population Health at Queen Mary University of London, said in a related press release. “There is also a need to provide [general practitioners] and pharmacists with the right tools to support patients to do this. In the next phase of this research program, we plan to provide practices with tools to support the identification and management of high-risk patients based on prescribing records.”

Reference:

• More than a quarter of people with asthma are still over-using rescue inhalers – putting them at increased risk of severe attacks and hospitalization. Published June 15, 2022. Accessed June 15, 2022.