The Association Between Short-Acting β-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia.

Joe Doan, Eric Bateman, Bruce Willet, Deb Stewart, Josephine Samuel-King, Alexander Roussos, Kanchanamala Ranasinghe, John Pakos, Dominique Novic, Chi Ming Lau, Chantal Le Lievre, Thao Le, Ata Kichkin, Kirsty Fletton, Victoria Carter, Angelina Catanzariti, Fabio Botini, Maarten Beekman, Porsche Le Cheng, Florian Heraud, Rebecca Vella, Kerry Hancock, Ruth Murray, Sinthia Bosnic-Anticevich, David Price, Christine Jenkins, Anita Sharma

Journal: Advances in therapy 2024;41(3):1262-1283

PMID: 38310584

Free Full Text on PubMed Central View on PubMed

Abstract

INTRODUCTION

In Australia, short-acting β-agonists (SABA) are available both over the counter (OTC) and on prescription. This ease of access may impact SABA use in the Australian population. Our aim was to assess patterns and outcome associations of prescribed, acquired OTC and reported use of SABA by Australians with asthma.

METHODS

This was a cross-sectional study, using data derived from primary care electronic medical records (EMRs) and patient completed questionnaires within Optimum Patient Care Research Database Australia (OPCRDA). A total of 720 individuals aged ≥ 12 years with an asthma diagnosis in their EMRs and receiving asthma therapy were included. The annual number of SABA inhalers authorised on prescription, acquired OTC and reported, and the association with self-reported exacerbations and asthma control were investigated.

RESULTS

92.9% (n = 380/409) of individuals issued with SABA prescription were authorised ≥ 3 inhalers annually, although this differed from self-reported usage. Of individuals reporting SABA use (n = 546) in the last 12 months, 37.0% reported using ≥ 3 inhalers. These patients who reported SABA overuse experienced 2.52 (95% confidence interval [CI] 1.73-3.70) times more severe exacerbations and were 4.51 times (95% CI 3.13-6.55) more likely to have poor asthma control than those who reported using 1-2 SABA inhalers. Patients who did not receive SABA on prescription (43.2%; n = 311/720) also experienced 2.71 (95% CI 1.07-7.26) times more severe exacerbations than those prescribed 1-2 inhalers. Of these patients, 38.9% reported using OTC SABA and other prescription medications, 26.4% reported using SABA OTC as their only asthma medication, 13.2% were prescribed other therapies but not SABA OTC and 14.5% were not using any medication.

CONCLUSION

Both self-reported SABA overuse and zero SABA prescriptions were associated with poor asthma outcomes. The disconnect between prescribing authorisation, OTC availability and actual use, make it difficult for clinicians to quantify SABA use.

Address: Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK. [email protected].; Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore. [email protected].; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK. [email protected].; Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia. [email protected].; Thoracic Physician Concord Hospital, Head Respiratory Trials, George Institute, University of Sydney, Sydney, Australia.; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, VIC, 3010, Australia.; RACGP Resp Medicine SIG, 100 Wellington Parade, East Melbourne, Melbourne, VIC, 3002, Australia.; Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia.; Queensland Health, Brisbane, QLD, Australia.; Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK.; BioPharmaceuticals Medical and Regional Medical Director for International, The Hague, The Netherlands.; Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.; Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, MSW, 2037, Australia.; AstraZeneca Biopharmaceuticals Medical, Medical Affairs, 66 Talavera Road, Macquarie Park, NSW, Australia.; HealthPlus Medical Centre, 28/26 Belgrave St, Kogarah, NSW, 2217, Australia.; Blue Shield Family General Practice, Kogarah, NSW, 2217, Australia.; Medical Education, and Events Management Pte Ltd, Singapore, Singapore.; Toukley Family Practice, 37-41 Canton Beach Road, Toukley, NSW, 2263, Australia.; Redlands Medical Centre, 189 Vienna Rd, Alexandra Hills, 4161, Australia.; Woodcroft Medical Centre, Woodcroft, SA, 5162, Australia.; School of Medicine, Griffith University, Gold Coast, Australia.; Cannon Hill Family Doctors, 17/1177 Wynnum Rd, Cannon Hill, QLD, 4170, Australia.; Ripponlea Medical Centre, Ripponlea, VIC, 3185, Australia.; Platinum Medical Centre, 18 Banfield St, Chermside, QLD, 4032, Australia.; School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia.; Victoria Point Surgery, Brisbane, QLD, 4165, Australia.; Department of Medicine, University of Cape Town, and University Cape Town Lung Institute, Cape Town, South Africa.

DOI: 10.1007/s12325-023-02746-0

Link outs

Free resources

Full Text Sources:

Medical:

https://medlineplus.gov/asthma.html

Subscription / membership required

Full Text Sources:

https://dx.doi.org/10.1007/s12325-023-02746-0

MeSH Terms: Humans, Administration, Inhalation, Asthma, Australia, Cross-Sectional Studies, Patient Reported Outcome Measures, Inappropriate Prescribing, Adrenergic beta-2 Receptor Agonists