Understanding SABA reliever use in those prescribed an anti-inflammatory reliever (AIR)

Background: New Zealand is an early adopter of the anti-inflammatory reliever, having recommended as-needed budesonide-formoterol as the preferred reliever across the spectrum of asthma for adults and adolescents since June 2020. Although there has been significant uptake of AIR, a degree of SABA co-prescription, previously been documented with MART prescribing, is suspected. This is not in line with the evidence on which the guidelines are based, and has the potential to undermine the benefits of reduction in both asthma exacerbations and carbon footprint. Methodology: Phase 1. PHO Prescribing Audit - Retrospective observational study of asthma prescribing in a large Primary Health Care Organisation (PHO) in Wellington, New Zealand. The primary outcome is the number of 500 consecutive budesonide-formoterol scripts intended for AIR in which a SABA reliever was prescribed in either the index script or the twelve months following. Ethics approval was obtained in September 2024 and data analysis will begin soon. Phase 2. Prescriber perspectives – Mixed-methods study of prescriber experiences of SABA reliever co-prescribing with an AIR. Prescriber survey as part of a peer group followed by immediate feedback, discussion and education. Phase 3. Patient perspectives - Explanatory sequential mixed-methods study exploring why patients prescribed AIR also use a SABA reliever. Survey followed by semi-structured interviews. Phase 2 and 3 Protocol are currently under development. The complementary Theoretical Domains Framework and COM-B Behaviour Change Wheel are being explored to provide a theoretical basis and structure for understanding this implementation challenge. Questions to discuss: - Other attendees/countries experiences of AIR and of SABA co-prescription - How implementation frameworks could enhance the theoretical and methodological background of this research - Important factors to consider with qualitative patient interviews Funding: The author(s) have received no direct financial support for this abstract. The MRINZ is supported by the HRC NZ Independent Research Organization Funding. Additional funding for this study has been applied for but no outcome has been received at this stage.