More than a quarter of patients misuse asthma reliever inhalers, study finds

The study results suggest that one in four asthma patients overuse short-acting β2-agonists (SABAs).

Researchers from the Clinical Effectiveness Group at Queen Mary University of London (QMUL) analyzed the anonymised records of 30,694 people with asthma from 117 GP practices in 3 east London boroughs.

Their analysis showed that 26% were prescribed at least six SABA inhalers in the year to February 2020, with 25% of these patients also underusing preventive corticosteroid inhalers.

The study, published in the British Journal of General Medicine on June 14, 2022, also found that repeat dispensing “was also strongly associated with the risk of overprescribing SABA.”

Lead author Anna De Simoni, GP and clinical lecturer in primary care at QMUL, said: “Working with patients to improve the regular use of preventer inhalers should be at the heart of reducing hospitalizations related to inhalation. ‘asthma.

“There is still plenty of room for improvement – ​​we have calculated that supporting patients who use more than 12 SABA inhalers per year to reduce their use to 4-12 could result in 70% fewer admissions to the hospital-related asthma in this group.”

She added that there is “also a need to provide GPs and pharmacists with the right tools to help patients 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 prescription records.”

The findings follow research published in February 2021, which found that 284,683 of 574,913 asthma patients in the UK’s SABA Use in Asthma (SABINA) program were found to be “potentially overusing” the drug.

Anna Murphy, consultant respiratory pharmacist at University Hospitals of Leicester NHS Trust, said she was ‘not surprised’ by the study results.

“If you look at patients coming into clinics, being admitted to hospital, that’s a classic behavioral finding in asthma,” she said.

“The overprescription of SABA is obviously [because] patients get a very fast release from the salbutamol inhaler. Unfortunately, it does not treat the underlying condition…and may increase the chances of causing anxiety [and] tachycardia.

“From a pharmacist’s perspective, there are a number of things that are really critical for us to do. The first is that we identify and monitor adherence to inhaled corticosteroids (ICS),” Murphy continued, recommending training modules led by the Oxford Academic Health Science Network.

She added that pharmacists can also educate patients on ways to remember to take ICS, adding that “we’ll probably use more smart inhalers to try to help with that” in the future.

In September 2021, NHS England launched detailed objectives for primary care networks to support improved respiratory care and health outcomes for people with asthma in 2021/2022 and 2022/2023.

The targets have been put in place to reduce avoidable carbon emissions by encouraging the choice of low carbon inhalers, when clinically appropriate.

However, the targets have been delayed until April 2022 to ease the workload for GPs during the Omicron COVID-19 surge.