Overuse of asthma rescue inhalers is common, varies by practice

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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 to identify predictors leading to overprescribing. In February 2020, the researchers evaluated 30,694 primary care medical records for: patients with asthma ages 5 to 80 from 117 practices in East London.

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

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

When SABA and inhaled corticosteroids (ICS) were converted to standard units, researchers saw an improvement in the accuracy of comparisons between different preparations, with 25% of patients with use six or more SABAs per year underutilization of ICS. According to the results, this proportion rose to 80% for patients prescribed six or more SABA inhalers per year.

Age over 60 years (OR = 1.34; 95% CI, 1.24-1.45) and the presence of four or more physical and mental co-morbidities (OR = 1.86; 95% CI, 1.61- 2.13) were associated with a higher risk of SABA overprescription.

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

“Working with patients to improve regular use of preventive inhalers should be central to reducing asthma-related hospital admissions. There is still a lot of 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 lead to a 70% reduction in asthma-related hospitalizations in that group, ” Anna De Simoni, MBBS, PhD, clinical teacher digital health at the Wolfson Institute of Population Health at Queen Mary University of London, said in a related press release. “We also need to take care of [general practitioners] and pharmacists with the right tools to support patients. 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 data.”


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