More than a quarter of people with asthma still use too many emergency inhalers, putting them at increased risk of serious attacks and hospitalization

Asthma is a common lung disease affecting 5.4 million people in the UK and can lead to symptoms such as coughing, wheezing or feeling breathless. Asthma is best controlled by regular use of a corticosteroid inhaler, which helps prevent symptoms. People with asthma can also use rescue or ‘SABA’ (short-acting beta-agonist) inhalers to quickly relieve symptoms when needed.

However, research has shown that it is common for people with asthma to overuse SABA inhalers (defined as six or more prescriptions per year), and that relying on SABA for relief rather than using corticosteroids to prevent symptoms is associated associated with poor asthma control and an increased risk of severe asthma attacks and hospitalizations. The National Review of Asthma Deaths in 2014 found evidence of overuse or overreliance on asthma relief inhalers in people who died of asthma. Electronic monitoring of primary care prescribing was strongly recommended.

In East London, where the Queen Mary University of London is located, hospitalization for acute asthma is 14% above the London average. Given the impact this has on our community, researchers from Queen Mary’s Clinical Effectiveness Group (CEG) analyzed more than 700,000 anonymized patient records at 117 primary care practices in East London. They found that 26% of patients with asthma are still prescribed too many SABA inhalers. Of this group, a quarter of them also underused preventive (corticosteroid) inhalers, raising concerns about inadequate prevention in a group of people with significant asthma.

Anna De Simoni, lead author and primary care physician and clinical lecturer at Queen Mary University of London, said:

“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 4-12 could lead to a 70% reduction in asthma-related hospitalizations in that group.

“It is also necessary to provide general practitioners and pharmacists with the right tools to support patients in 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 data.”

The study also found that prescribing varies significantly between GP practices, with some overprescribing to 6% of their asthma patients and some overprescribing to as many as 60%. Further analysis of the variation revealed that overprescribing was strongly associated with repeat dispensing (where prescriptions are automatically dispensed by community pharmacists).

Paul Pfeffer, co-author and Consultant Respiratory Physician with special interest in asthma at Barts Health NHS Trust, said:

“There is a continuing high burden of inappropriate and dangerous overuse of rescue inhalers in asthma, and our paper highlights the complexity of the problem with multiple reasons why patients are prescribed too many SABA inhalers. The findings call for more detailed research into interventions to address inappropriate overuse of SABA in different patient groups.”

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