Asthma is a common lung condition that affects 4 million people in France and 334 million worldwide and can lead to symptoms such as coughing, wheezing and shortness of breath. Asthma is best controlled by regular use of a corticosteroid inhaler, which prevents symptoms from appearing. People with asthma can also use “SABA” rescue inhalers to quickly relieve symptoms when needed.
Working with patients to improve the use of SABA inhalers
In practice and on a daily basis, people with asthma abuse SABA inhalers which should only be prescribed 6 times a year and this overuse frequently replaces the use of corticosteroid inhalers, which ultimately promotes poor asthma control and increased severe asthma attacks and risk of hospitalization.
The study is based on a national (UK) review of asthma-related death data in 2014. This analysis indeed identifies:
- evidence of overuse or even reliance on rescue inhalers in people who died of asthma;
- moreover, the analysis of 700,000 patient records followed in 117 general practitioner offices reveals that 26% of asthmatic patients still receive too many prescriptions for SABA inhalers. And, among these over-users, a quarter under-use corticosteroid inhalers, which is worrying in terms of the effectiveness of the treatment of severe asthma;
- Finally, the prescription of these inhalers varies considerably from one GP practice to another, with some practicing over-prescription for 6% and others for 60% of their asthma patients. Further analysis of the variation revealed that over-prescribing is strongly related to prescriptions with renewable dispensing.
The prescription of these inhalers must therefore be much more rigorous in primary care, underline these researchers, based in East London, where hospitalizations for acute asthma are 14% higher than the London average. Lead author Dr Anna De Simoni, senior author, general practitioner and professor of primary care at Queen Mary University of London, comments on these findings:
“Working with patients to improve the use of preventer inhalers must be central to reducing asthma-related hospitalizations. There is still a lot of room for improvement”.
- The team estimated that advising patients who use more than 12 SABA inhalers per year to reduce their use to around 4 could lead to a 70% reduction in asthma-related hospitalizations.
“General practitioners and pharmacists also need to have the right tools to help patients. We plan to develop new tools to support the identification and management of high-risk patients, based on their prescription data”.