Prescriptions of short-acting β2-agonists in patients with asthma in primary care: a SABINA III multicountry analysis

Aim: Primary care physicians (PCPs), the first point of contact for most patients with asthma, exert a major influence on asthma care. To understand asthma medication prescription patterns in primary care globally, we describe the primary care cohort of SABINA III. Methods: In this cross-sectional study conducted in 24 low-to-high resourced countries, asthma patients (≥12 years) were recruited from March 2019–January 2020. Data on investigator-classified asthma severity (guided by 2017 Global Initiative for Asthma report), severe exacerbations, asthma symptom control and prescribed asthma treatments, including short-acting β2-agonists (SABA; ≥3 canisters associated with poor asthma outcomes1), during 12 months before the study visit were collected using electronic case report forms. Results: Of 8,351 patients analysed, 17.2% (n=1,440) were enrolled by PCPs and the rest by specialists. In primary care, 51.7% and 48.3% had mild and moderate-to-severe asthma, respectively. No medication reimbursement was reported for 35.5% of PCP-treated patients vs 27.3% overall. Overall, 45.4% experienced ≥1 severe exacerbation and among PCP-treated mild asthma patients, 39.0% and 13.7% had ≥1 and ≥3 severe exacerbations, respectively (Table). Uncontrolled/partly controlled asthma was observed in 58.3% of all PCP-treated patients and 57.2% of PCP-treated mild asthma patients. Among PCP-treated patients prescribed SABA monotherapy, 60.6% were prescribed ≥3 canisters (vs 53.6% overall) and 45.0%, ≥10 canisters (vs 29.9% overall). In addition to maintenance therapy, 69.0% of PCP-treated patients were prescribed ≥3 SABA canisters (vs 61.7% overall) and 38.2%, ≥10 canisters (vs 29.3% overall). Moreover, 21.5% of PCP-treated patients purchased SABAs over the counter (OTC); 40.5% purchased ≥3 canisters. Conclusion: High exacerbation burden and poor asthma control were observed in PCP-treated patients, even in those with “mild” asthma. SABA monotherapy prescriptions and OTC purchase of ≥3 canisters were substantial in primary care. Reducing SABA overreliance in primary care, per current evidence-based guidelines, may thus improve clinical outcomes. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The study was designed and funded by AstraZeneca. References and Clinical Trial Registry Information Bloom CI, et al. Adv Ther. 37, 4190-4208 (2020).