High prescribing of short-acting reliever inhalers 'suggests asthma guidance not being followed'

Frequent prescribing of short-acting ß2 agonists (SABA) is widespread even in mild asthma, a new UK study shows, despite global guidance no longer recommending these medications alone for symptom relief.

High use of short-acting beta2 agonists is associated with increased exacerbations and healthcare utilisation. | GETTY IMAGES

The Global Initiative for Asthma advises against using SABA alone for symptom relief. However, more than one third of asthma patients in the UK use 3 or more SABA inhalers a year, according to a UK study of more than half a million patients.

The study found high SABA use was common even in patients with mild asthma and was associated with a significant increase in exacerbations and healthcare utilisation.

The authors point out that SABA do not address the underlying airway inflammation in asthma and highlight 'the need to align SABA prescription practices with current treatment recommendations'.


Researchers from Imperial College London, the Karolinska Institute in Sweden, and AstraZeneca, conducted a retrospective longitudinal observational study using the UK Clinical Practice Research Datalink to identify primary care records from the period 2007–2017 for asthma patients aged?at least 12 years.

Of the 574,913 asthma patients included in the analysis, the majority (65%) were receiving treatment corresponding to BTS (British Thoracic Society) step 1 or 2 and were considered to have mild asthma.

Overall, 218,365 (38%) patients had high SABA use, defined as 3 or more inhalers per year. High SABA use was seen among 26% of patients with mild asthma and 57% of patients with moderate to severe asthma (BTS steps 3–5).

Among the 336,412 patients with linked hospital data, the researchers found that high SABA use was associated with a significant increase in exacerbations and asthma-related healthcare utilisation – both primary care and specialist visits. The rate of exacerbations was almost double in high SABA users compared with low SABA users.

These associations persisted regardless of treatment step or asthma severity and after adjusting for confounding factors such as exacerbation history, indicating that high use of SABA inhalers may contribute to poor clinical outcomes in this subset of patients.

'These real-world findings therefore appear to support the concept of treating mild asthma patients with anti-inflammatory medications and not just a short-acting bronchodilator alone,' the authors said.

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