Overuse of asthma reliever inhalers common, varies by practice

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According to new data published in the British Journal of General Medicine.

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

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

The researchers reported a 10-fold variation in SABA inhaler prescribing between different practices, ranging from 6% to 60% in the proportion of patients using at least six SABA inhalers per year, depending on the results.

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

Age over 60 years (OR = 1.34; 95% CI, 1.24-1.45) and the presence of at least four physical and mental comorbidities (OR = 1.86; 95% CI, 1.61-2.13) were associated with a higher risk of overprescribing SABA.

Additionally, prescribing modality strongly predicted SABA overprescription, as repeat distribution was strongly associated with SABA overprescription (OR = 6.52; 95% CI, 4.64-9.41), wrote the researchers. Other independent predictors of SABA overprescription were increased asthma severity and multimorbidity.

“Working with patients to improve the regular use of preventer inhalers should be at the heart of reducing asthma-related hospitalizations. There is still a lot of room for improvement – we have calculated that helping reducing patients who use more than 12 SABA inhalers per year to 4 to 12 could result in 70% fewer asthma-related hospitalizations in this group,” Anna De Simoni, MBBS, PhD, clinical lecturer in digital health at Wolfson Institute of Population Health at Queen Mary University of London, said in a related press release. “We must also provide [general practitioners] and pharmacists with the right tools to help patients do just that. 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.