Background: Excess prescription and use of short-acting beta-agonist (SABA) inhalers is associated with poor asthma control and increased risk of hospital admission. Aim: To quantify the prevalence, and identify the predictors of SABA overprescribing. Design and Setting: Cross-sectional study using anonymised clinical and prescribing data from the primary care records in three contiguous east London boroughs. Methods: Primary care medical record data for patients aged 5 – 80 years, with ‘active’ asthma were extracted in February 2020. Explanatory variables included demography, asthma management, co-morbidities and prescriptions for asthma medications. Results: In the study population of 30,694 people with asthma, 26% were prescribed ≥6 SABA inhalers in the previous year. A ten-fold variation between practices (<6% to 60%) was observed in the proportion of patients on ≥6 SABA inhalers/year. By converting both SABA and ICS to standard units we improved the accuracy of comparisons across different preparations. 25% of those taking ≥6 SABA/year were underusing ICS, this rose to 80% for those prescribed <6 SABA/year. Prescription modality was a strong predictor of SABA overprescribing, with repeat dispensing strongly linked to SABA overprescribing (OR 6.52, (95% CI 4.64 to 9.41)). Increasing severity of asthma and multimorbidity were also independent predictors of SABA overprescribing. Conclusion: In this multi-ethnic population a fifth of practices demonstrate an overprescribing rate of <20% a year. Based on previous data, supporting practices to enable the SABA≥12 group to reduce to 4-12 /year could potentially save up to 70% of asthma admissions a year within that group.
BackgroundOver-prescription of short-acting beta-agonist (SABA) inhalers and blood eosinophil count have strong associations with exacerbation risk in asthma. However, in our recent publication only a minority of SABA-overprescribed patients (≥6 inhalers in 12 months) were eosinophilic (≥0.3x109cells/L).AimTo compare the characteristics of eosinophilic and non-eosinophilic SABA over-prescribed patients, and identify latent classes using clinical variables available in primary care.Design & settingCross-sectional analysis of asthmatic patients in North East London using primary care electronic health record data.MethodUnadjusted and adjusted multi-variate regression models and latent class analysis.ResultsEosinophilia was significantly less likely in female patients, those with multiple mental health comorbidities and those with SABA on repeat prescription. Latent class analysis identified 3 classes of SABA over-prescribed patients representing those with classical Uncontrolled Asthma (oral-steroid requiring exacerbations, step 2–3 asthma medications, high probability of being eosinophilic), Mild Asthma (low exacerbation frequency, low asthma medication step, low probability of being eosinophilic), and Difficult Asthma (high exacerbation frequency despite high-strength preventer inhalers, low probability of being eosinophilic). The Mild Asthma class was the largest.ConclusionMany patients being over-prescribed SABA are non-eosinophilic with a low exacerbation frequency suggesting disproportionately high SABA prescription compared to other asthma control markers. Potential reasons for high SABA prescription in these patients include repeat prescription (being dispensed but not taken) and use of SABA for non-asthma breathlessness (eg, breathing pattern disorders with anxiety). Further research is needed into management of SABA overuse in patients without other markers of uncontrolled asthma.
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