More than a quarter of people with asthma still overuse rescue inhalers, putting them at increased risk of severe attacks and hospitalization

Asthma is a common lung condition that affects 5.4 million people in the UK and can lead to symptoms such as coughing, wheezing or 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 rescue inhalers or “SABAs” (short-acting beta-agonists) 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 instead of using corticosteroids to prevent symptoms is linked to poor asthma control and an increased risk of severe asthma attacks and hospitalizations. The 2014 National Review of Asthma-Related Deaths found evidence of overuse or overreliance on reliever inhalers in people who died of asthma. Electronic prescribing monitoring in primary care has been urgently recommended.

In East London, where Queen Mary University of London is located, hospitalizations for acute asthma are 14% higher than the London average. Considering the impact this is having on our community, researchers from Queen Mary’s Clinical Effectiveness Group (CEG) analyzed over 700,000 anonymised patient records from 117 GP practices in East London. They found that 26% of asthma patients still prescribe too many SABA inhalers. In this group, a quarter also underused preventer inhalers (corticosteroids), raising concerns about inadequate prevention in a large group of people with asthma.

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

“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 4-12 could result in a 70% reduction in asthma-related hospitalizations in this group.

“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 study also found that prescribing varies widely across GP practices, with some over-prescribing 6% of their asthma patients and others 60%. Further analysis of the variation revealed that overprescribing was strongly related to repeat dispensing (where prescriptions are dispensed automatically by community pharmacists).

Paul Pfeffer, co-author and consultant respiratory physician with a special interest in asthma at Barts Health NHS Trust, said:

“There is a continuing major burden of inappropriate and unsafe overuse of rescue inhalers in asthma, and our article highlights the complexity of the problem with multiple reasons why patients are over-prescribed SABA inhalers. results call for more detailed research into interventions to reduce inappropriate SABA overuse in different patient groups.”

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