Abuse of short-acting beta agonists “a global public health problem”
About a third of asthma patients have high use of short-acting beta-agonists (SABA) in Europe at all levels of severity, said Santiago Quirce, MD, PhD, University Hospital Madrid, Spain.
High usage – defined as three or more cartridges dispensed per year – “is a global public health problem,” and is associated with an increased risk of asthma exacerbations and death, he said, as well as ‘to an increase in healthcare costs.
Asthma patients tend to rely too much on SABA and too little on inhaled corticosteroids (ICS), he said at the European Academy of Allergy and Clinical Immunology (EAACI) 2021 Hybrid Congress on Saturday, adding that the use of SABA continues to increase around the world.
Quirce is co-author of the SABINE study, the largest real-world study on the use of SABA. It included 1 million people with asthma in five European countries. Among the results, overuse varied considerably among countries.
Overuse was 9% in Italy; 16% in Germany; 29% in Spain; 30% in Sweden; and 38% in the UK. In the UK, overuse of BACA was greater in people with moderate to severe asthma than in those with mild asthma (58% vs. 27%, respectively.)
Quirce too highlighted a 2012 study in the Annals of Allergy, Asthma and Immunology of over 33,000 patients who identified SABA values that predicted exacerbations in children in adults.
For adults, “the use of 2 or more SABA cartridges was considered the critical value with shorter optimal evaluation periods of 3 and 6 months,” the 2012 study found. “Each cartridge of SABA further resulted in an 8% to 14% increase ”in the risk of asthma-related exacerbation in children and“ a 14% to 18% increase ”in this risk in adults.
Patients are becoming too dependent on SABA inhalers, which have been used for over 50 years, for many reasons, Quirce said, despite the increased risk of exacerbations.
He noted that educating patients and healthcare workers about the risks of SABA overuse is difficult, in part because inhalers provide quick relief, are easy to use, and are inexpensive.
However, the 2019 Global Asthma Initiative (GINA) the guidelines no longer recommend SABAs alone to treat asthma in adolescents and adults.
“[SABA overreliance] is one of the biggest problems we have in managing asthma, ”he said.
Quirce said that a better shared understanding of the overuse of ABAS is needed, “so that specialists and general practitioners are fully aware of the problem.” It is also important to communicate this to patients, he said.
The gaps in understanding overuse are wide
Researchers conduct a study Posted in NPJ Primary care Respiratory medicine interviewed asthma experts from hospital and primary care settings to identify how ABAS use is defined and perceived. They found that providers’ definition of “acceptable use of SABA” ranged from 0.5 inhaler of SABA (100 doses per year) to 12 inhalers of SABA (2,400 doses / year).
Quirce suggests a “red flag or warning” from community pharmacists and the efforts of scientific organizations to highlight the problem.
Additionally, usage restrictions vary widely around the world.
Session moderator Stefano Del Giacco, MD, associate professor of allergy and clinical immunology at the University of Cagliari, Cagliari, Italy, said: “In Italy we can take (SABA) without a prescription because it is considered an emergency medication. If you run to the pharmacy and ask for it, they’ll give it to you immediately. “
The lack of prescriptions, and therefore the lack of prescription data, may also help explain why the number of overuse in Italy is lower than in other European countries, Quirce said.
Del Giacco said he was in favor of instituting “red flags” at the pharmacy level.
Stanley Szefler, MD, director of Pediatric asthma The research program and medical director of research at the Breathing Institute at Children’s Hospital Colorado in Denver, said Medscape Medical News he suspects that SABA addiction is similar in the United States and Europe. He said that patients are also likely to guide decisions to use SABA based on quick relief and low cost.
“This is where close monitoring of the prescription on a population basis could be helpful in identifying these patients and seeing what is going on,” he said.
He noted that in the United States, insurer Kaiser Permanente has implemented a “SABA / ICS rationing system” to detect patients who are overly dependent on SABA.
Quirce receives honoraria, is on the speakers’ bureau or is a consultant for ALK, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Regeneron, Sanofi and Teva. Szefler and Del Giacco did not disclose any relevant financial relationship.
European Academy of Allergy and Clinical Immunology (EAACI) Hybrid Congress 2021: Plenary Session: New Frontiers in Asthma / Landscape of Short-Acting Beta-Agonists in Europe. Presented July 10, 2021.
Marcia Frellick is a freelance journalist based in Chicago. She previously wrote for the Chicago Tribune, Science News, and Nurse.com, and was an editor for the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.