Global Quality Statements on Reliever Use in Asthma in Adults and Children Older than 5 Years of Age

Abstract

Introduction Widespread misuse of short-acting beta-agonists (SABAs) may contribute to asthma-related morbidity and mortality. Recognizing this, the Global Initiative for Asthma neither recommends SABA monotherapy nor regards this formulation as a preferred reliever. Many health systems and healthcare professionals (HCPs) experience practical issues in implementing guidelines. Clear quality standards can drive improvements in asthma care and encourage implementation of global and national medical guidelines. Methods A steering group of global asthma experts came together between May and September 2019 to develop quality statements codifying the minimum elements of good quality asthma care. These statements were either evidence based (when robust evidence was available) or reflected a consensus based on clinical expertise and experience of the group. Results The quality statements (and associated essential criteria) developed emphasize key elements concerning (1) objective diagnosis specific to individual symptoms, (2) treatment appropriate to the long-term management of asthma as an inflammatory disease, consistent with evidence-based recommendations, (3) controlled dispensing of SABA canisters and monitoring to prevent overuse, (4) regular review of patients after treatment initiation or change, and (5) follow-up of patients in primary care after treatment for an exacerbation in a hospital or an emergency department. Conclusions The steering group proposes quality statements that national and local clinical groups can implement as quantitative quality standards that are appropriate to their local circumstances, including during the coronavirus disease 2019 (Covid-19) pandemic. By translating these statements into locally relevant quality standards, primary care physicians and HCPs can encourage optimal management and reduce preventable healthcare interactions. The evidence-based evolution of care encapsulated in these statements will further engender high-quality, patient-centered holistic management that addresses asthma as an inflammatory disease. In particular, the statements empower self-management by patients and encourage health-promoting behaviors, which are essential to reduce exacerbations, the primary goal of asthma management. Graphic abstract

Is overreliance on short-acting β2-agonists associated with health risks in the older asthma population?

“…For example, older age, [14,15] being female, [15] reliance on SABA monotherapy [16,17] as their sole treatment, and comorbid conditions (e.g. diabetes and hypertension) [18] were associated with a higher risk of mortality.…”

“…Previous literature suggests that the risk of mortality in the asthma population was multifaceted. For example, older age [ 14 , 15 ], being female [ 15 ], reliance on SABA monotherapy [ 16 , 17 ] as their sole treatment, and comorbid conditions ( e.g. diabetes and hypertension) [ 18 ] were associated with a higher risk of mortality.…”

A Shift in Asthma Treatment According to New Guidelines: An Evaluation of Asthma Patients’ Attitudes towards Treatment Change

“…According to the interviewees, involving the patient would result in them being more engaged in their asthma treatment and gaining a better understanding of their drug treatment and disease. Increased patient engagement is associated with increased patient satisfaction, increased adherence and compliance and better quality of life [ 29 , 30 , 31 ]. Therefore, an increased focus on improving patient involvement during consultations with GPs is a key initiative that could influence successful treatment shifts in asthma patients.…”

Challenges and recommendations for the management of asthma in the Middle East and Africa

“…[ 55 56 57 ] According to a European survey-based study, approximately 39% of patients who received more than 12 canisters of SABA inhalers during the previous year died of asthma. [ 58 ]…”

“…Patients requiring more than three canisters of SABAs per year are recommended to undergo detailed clinical assessment. [ 1 58 ] It is recommended to use as-needed low-dose ICS and formoterol as the preferred rescue option when ICS/formoterol combination is used for the management of asthma or one of the options for mild cases. [ 58 ] When ICS is combined with LABAs other than formoterol, SABA is the recommended option as a reliever.…”