Understanding reliever overuse in patients purchasing over-the-counter short-acting beta2 agonists: an Australian community pharmacy-based survey

Elizabeth A Azzi (Corresponding Author), Vicky Kritikos, Matthew J Peters, David B Price, Pamela Srour, Biljana Cvetkovski, Sinthia Bosnic-Anticevich

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OBJECTIVES: Overuse of asthma relievers is associated with significant adverse consequences. This study aimed to better understand the population purchasing and using short-acting beta agonists (SABA) over the counter (OTC); and compare the demographic, clinical and behavioural characteristics of those who overuse SABA with those who do not.

DESIGN AND SETTING: Real-world cross-sectional observational study in community pharmacy.

PARTICIPANTS: Of 412 participants ≥16 years requesting SABA OTC, 289 were SABA overusers (used SABA more than twice per week in the past 4 weeks).

MAIN OUTCOME MEASURE: Reliever use, Global Initiative for Asthma-defined control, healthcare utilisation, patterns of preventer use.

RESULTS: 70.1% of participants were classified as SABA overusers, that is, reporting SABA use more than twice a week within the last 4 weeks, 73.6% reported not using a preventer daily and only 81.6% reported a doctor diagnosis of asthma. SABA overusers were more likely to have moderate-severe nasal symptoms (80.8% vs 63.0%, p<0.001) and a diagnosis of depression (11.1% vs 5.7%, p<0.001), when compared with SABA non-overusers. A higher proportion of SABA overusers had uncontrolled asthma (59.0% vs 15.4%, p<0.001), were more likely to use oral corticosteroids to manage worsening asthma symptoms (26.2% vs 13.5%, p<0.01) and visit the doctor for their asthma in the past 12 months (74.5% vs 62.5%, p<0.01), when compared to SABA non-overusers.

CONCLUSIONS: This study uncovers a hidden population of people who can only be identified in pharmacy with suboptimal asthma, coexisting rhinitis, poor preventer adherence and, in some cases, no asthma diagnosis.

Original languageEnglish
Article numbere028995
Number of pages11
JournalBMJ Open
Issue number8
Early online date14 Aug 2019
Publication statusPublished - 14 Aug 2019



  • asthma
  • chronic airways disease
  • respiratory medicine (see thoracic medicine)

ASJC Scopus subject areas

  • Medicine(all)

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