Ending the reign of short-acting β2-agonists in Australia?

Background: Overuse of short-acting β2-agonists (SABA) to manage asthma increases the risk of adverse outcomes. Over the counter (OTC) SABA availability and automated provision of up to 12 inhalers/prescription has created the perfect storm for potential SABA overuse in Australia.

Aim: To investigate the relationship of readily accessible SABA (OTC and prescription) on self-reported asthma outcomes in the Australian population.

Methods: Data from electronic medical records (EMR) and questionnaires from patients ≥12 years-old were extracted from the Optimum Patient Care Research Database Australia. The annual number of SABA inhalers prescribed and used was quantified, and the impact of overuse (≥3 inhalers/year) on self-reported severe exacerbations and asthma control assessed.

Results: Of the 720 patients included the potential for SABA overuse (as per EMR) occurred in 52.8% of cases and was self-reported by 28.1% of patients. Those who self-reported use of ≥3 SABA inhalers/year experienced 2.53 times (95% CI 1.74–3.70; p < 0.001) as many severe exacerbations and were 4.51 times (95% CI 3.13–6.55; p < 0.001) more likely to have poorly controlled asthma than those who reported using 1–2 inhalers (Table 1). No reported SABA prescription was also associated with an increased risk of severe exacerbations (IRR 2.68; 95% CI 1.06–7.19; p = 0.04).

Conclusion: Ready access to self-reported SABA overuse is associated with poor asthma outcomes. A possible reason for the increased risk of severe exacerbations observed in patients with zero SABA prescriptions is the existence of a hidden population overusing OTC SABA. Removal of the default settings for repeat SABA prescriptions, monitoring OTC purchases, promotion of clinician and pharmacist review and patient education may address excessive SABA use in Australia.