Over-prescription of short-acting beta agonists in the treatment of asthma

Aim:Despite a clear guideline for asthma medication, overuse of short-acting β2-agonists (SABAs) seems to be common in clinical practice. Guidelines state that when patients need a SABA more than two times a week, inhaled corticosteroids (ICS) should be added. This study examines degree of overuse for SABAs (with and without use of ICS) in asthma patients in primary care and whether excessive use of SABAs is associated with exacerbations. Method:This is a retrospective study using electronical medical records from patients aged 18 and older of five Primary Care centers, in the period of July 1st, 2018 through July 1st, 2019 in the Netherlands. Excessive SABA use was defined as > 400 inhalations per year. Results:A total of 1161 patients were included in the study. Of the 766 patients using a SABA, 193 (25%) overused SABAs. Among the patients with inappropriate SABA use 41% did not use enough ICS for maintenance treatment. The odds of having an exacerbation were 2.9 times higher in case of SABA overuse compared to appropriate SABA use (OR, 2.897; 95% CI, 1.87-4.48). Conclusion:This study provides important insights into the medication use of asthma patients and shows that overuse of SABAs is alarmingly common and associated with poorer asthma control. It highlights that clinicians need to be alert to this and need to adjust the treatment of patients who might be at risk. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest No potential conflict of interest to report References and Clinical Trial Registry Information