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September 2020

Frequent prescribing of SABA alone still widespread

A new study shows high use of short-acting bronchodilators (SABA) is common even in patients with mild asthma, with more than a third of asthma patients in the UK using three or more reliever inhalers a year, leading to poor outcomes.

A real world study carried out over the 10 years from 2007 to 2017 in more than half a million asthma patients aged 12 years or older found that high SABA users were significantly more likely to experience exacerbations, and attend primary care or specialist consultations, regardless of asthma severity.

Among eligible patients, only 18% had more than 75% of days covered by a prescription for inhaled corticosteroids, and 53% were not prescribed ICS at all.

High SABA use was seen among 26% of patients with mild asthma (BTS steps 1–2) and 57% of patients with moderate to severe asthma (BTS steps 3–5).

The proportion of patients at BTS steps 1-2 and BTS steps 3-5 who experienced at least one exacerbation was 7% and 24%, respectively.

Exacerbations were defined as worsening of asthma needing a short course of oral corticosteroids, an A&E visit, hospital admission or asthma-related death.

Exacerbations were 1.7-2.2 times higher among high SABA users (≥3 inhalers a year) than low SABA users (0-2 inhalers a year).

The association between high SABA use and exacerbations persisted regardless of treatment step or asthma severity, and after adjusting for exacerbation history, indicating that high SABA use may contribute to poor clinical outcomes.

Both BTS and GINA recommend that patients with so-called mild asthma should not be treated with SABA alone. GINA recommends combination low-dose ICS-formoterol as preferred reliever therapy, ensuring that as the need for reliever therapy increases, so does the dose of ICS.

The authors have called for more education for patients and healthcare providers to ensure that SABA prescribing is aligned with current treatment recommendations.

Bloom CI, et al. Advances in Therapy, 27 July 2020.

Practice Nurse 2020;50(7):6