Relying on rescue or ‘SABA’ (short-acting beta-agonist) inhalers to quickly relieve symptoms of asthma rather than preventative corticosteroid inhalers has been linked to poor asthma control and an increased risk of severe asthma attacks and hospital admissions.
However, many patients are being overprescribed SABA inhalers, a study carried out at Queen Mary University of London has found.
Overuse of SABA inhalers can mask the progression of the disease as it can lead to patients overestimating the control they have over symptoms. It can also increase the responsiveness in the airways, leading to greater sensitivity to triggers.
A team of researchers from Queen Mary’s Clinical Effectiveness Group (CEG) analysed records from more than 700,000 anonymised asthma patients aged between 5 and 80 taken from more than 100 GP practices across East London.
They found that 26 per cent of the patients were receiving six or more SABA inhaler prescriptions per year, with some receiving more than 12. Additionally, one quarter of them were deemed to be underusing preventative corticosteroid inhalers.
“Working with patients to improve regular use of preventative inhalers should be central to reducing asthma-related hospital admissions," said lead author Dr Anna De Simoni, GP and Clinical Lecturer in Primary Care at Queen Mary's. "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 4-12 could result in 70 per cent fewer asthma-related hospital admissions in that group,”
The study also found that the degree of overprescribing varies significantly between GP practices. Some practices were overprescribing inhalers to 6 per cent of their asthma patients and others were overprescribing to as many as 60 per cent. This variation was strongly linked to patients receiving repeat prescriptions that are issued automatically by community pharmacists.
“There is also a need to provide GPs and pharmacists with the right tools to support patients to do this. In the next phase of this research programme, we plan to provide practices with tools to support the identification and management of high-risk patients based on prescribing records,” said De Simoni.
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