Over-prescription of short-acting β<sub>2</sub>-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study

Khattab, A.; Madkour, Ashraf; Ambaram, Anish; Smith, C; Muhwa, Chakaya J; Mecha, Jerphason; Alsayed, Mohamed; Beekman, Maarten

doi:10.1080/03007995.2022.2100649

Cited by 9 publications

(12 citation statements)

References 49 publications

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“…Of concern, 60.6% of patients from Saudi Arabia were overprescribed SABA. Although these prescription patterns were comparable to those reported in the Gulf cohort (Kuwait, Oman, and the United Arab Emirates) of the SABINA III study where 58.5% patients were overprescribed SABA, 19 this was considerably higher than that observed in the overall SABINA III cohort of 8351 patients where 38.0% of patients received ≥3 SABA prescriptions, 16 and the Middle Eastern ( n = 1389), 20 African ( n = 1778), 21 Latin American ( n = 1096), 22 and Asian ( n = 3066) 23 cohorts of SABINA III, where 47.1%, 46.5%, 39.8%, and 26.1% of patients, respectively, were prescribed ≥3 SABA canisters in the 12 months prior to study initiation. Similarly, rates of SABA overprescription in this Saudi Arabian cohort were higher than those reported from a pan‐European study, which was conducted as part of the SABINA programme in 1.06 million patients with asthma, and reported the prevalence of SABA overuse to be 9.0% in Italy, 16.0% in Germany, 29.0% in Spain, 30.0% in Sweden, and 38.0% in the United Kingdom 24 .…”

Section: Discussionsupporting

confidence: 73%

Overprescription of short‐acting β₂‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Al‐Jahdali

Wali

Albanna

et al. 2022

Clinical Respiratory J

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Despite near-universal health care and timely updates to treatment guidelines in Saudi Arabia, asthma control remains suboptimal, warranting deeper exploration of its management practices. This study describes asthma characteristics and prescription patterns of short-acting β 2 -agonists (SABAs) in the Saudi Arabia cohort of the SABA use IN Asthma (SABINA) III study. Patients with asthma (aged ≥12 years) from seven sites across Saudi Arabia participated in this cross-sectional study. Asthma severity was classified by study investigators, guided by the 2017 Global Initiative for Asthma (GINA) recommendations. Of 511 patients enrolled, 502 patients, treated by respiratory medicine specialists, were analyzed (mean [standard deviation] age, 47.5 [14.8] years; female, 68.5%). Most patients had moderate-to-severe asthma (89.6%, GINA treatment steps 3-5), were overweight/obese (78.9%), and received full health care reimbursement (83.4%). Asthma was partially controlled/ uncontrolled among 64.3% of patients; 62.3% experienced ≥1 severe asthma exacerbation(s), and 60.6% and 41.2% were prescribed ≥3 (overprescription) and ≥10 SABA canisters, respectively, in the 12 months preceding study

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Section: Discussionsupporting

confidence: 73%

Overprescription of short‐acting β₂‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Al‐Jahdali

Wali

Albanna

et al. 2022

Clinical Respiratory J

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“…The 18 studies reported data from various countries with different income levels based on World Bank classification [ 9 , 15 , 35 – 50 ]. A total of 11 high-income countries were represented, in data collected from Australia, Chile, Italy, Kuwait, Oman, Saudi Arabia, Singapore, South Africa, South Korea, Taiwan, and The United Arab Emirates.…”

Section: Resultsmentioning

confidence: 99%

Over-the-counter use of short-acting beta-2 agonists: a systematic review

Loh,

Hussain,

Ong

et al. 2023

J of Pharm Policy and Pract

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Background The widespread use of short-acting beta-2 agonists (SABA) as an as-needed treatment for asthma is well-established. However, excessive use of SABA has been linked to undesirable outcomes such as increased risk of asthma attacks, exacerbations, and even death. The availability of SABA as an over-the-counter (OTC) medication has contributed to their overuse, leading to undertreated asthma and reduced access to asthma education. Objective This systematic review aimed to summarize the prevalence, characteristic features of, and factors contributing to over-the-counter SABA purchase or overuse. Methods The databases searched included PubMed, Scopus, Springer Link, Google Scholar, CINAHL, and APA PsycArticles. Original research articles reporting the prevalence, characteristics features, and factors regarding over-the-counter SABA use, available as full text, published in English language between the year 2000 and April 2023 were included in this review. Commentaries, letters to editor, review articles, qualitative studies, clinical trials, and conference proceedings were excluded. Data extraction was followed by a review of the quality of studies included and data were then synthesized for meaningful findings. This systematic review had been registered in the PROSPERO with registration number CRD42023421007. Results A total of 18 articles were included. The prevalence range of OTC SABA users in populations were 1.4% to 39.6% and SABA over-users among OTC users were 14% to 66.4%. Factors mostly associated with this behavior were moderate–severe asthma, and less use of preventers. On top of that, not understanding the risk of SABA overuse was clear in many studies that explored this factor. Conclusion Over-the-counter purchase and overuse of SABA medication is a common problem, leading to adverse consequences such as uncontrolled asthma and increased healthcare utilization. Addressing these issues requires improved patient education about their conditions and adequate information regarding the potential long-term effects of SABA use by the healthcare providers. Management and education of asthma patients, including regular monitoring and follow-up, can help reduce overuse of SABA medication and prevent negative consequences.

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“…Findings from this African cohort of the SABINA III study indicate that SABA over-prescription and SABA over-thecounter purchase are common and associated with poor asthma-related outcomes. This highlights the need for healthcare providers/policymakers to align clinical practices with the latest treatment recommendations [27].…”

Section: Discussionmentioning

confidence: 99%

“…A 4-point scale indicates degree of severity; items are rated from 0 (not at all) to 3 (extreme form of each symptom). The Beck Depression Inventory Scores Interpretation: minimal range (0-13), mild depression (14)(15)(16)(17)(18)(19), moderate depression (20)(21)(22)(23)(24)(25)(26)(27)(28), and severe depression (29-63) [13].…”

Section: Beck Depression Inventory 2 (Bdi-ii)mentioning

confidence: 99%

Acute severe asthma in emergency department: clinical characteristics, risk factors, and predictors for poor outcome

et al. 2022

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Background Severe asthma exacerbation can be a frightening experience to the patient and physician. Despite continuous efforts to frame management guidelines and advances in treatment, severe exacerbations still occur. In order to prevent and judicious management of asthma exacerbations, we should predict them first. This study aims to evaluate distinct clinical trajectories and management outcome of patients with severe asthma exacerbations and also evaluate predictors for poor outcome. Methods Patients suffering from acute asthma exacerbation and presented to emergency room (forty patients) were grouped into 2 groups (groups A and B) according to severity of exacerbation. Assessment included full clinical history, laboratory investigations (including eosinophil cell count and serum IgE level), Beck’s anxiety and depression inventory scales, assessment of asthma medication adherence and control level, and peak expiratory flow measurement (at presentation, 1 and 6 h after). Results Fifty-five percent of patients suffered from severe and life-threatening asthma exacerbations, 63.6% of them were females. The most important predictors for severe exacerbations were SO2 < 90% at baseline (OR = 4.56; 95% CI = 3.45–7.56; P < 0.001), PEFR after 1 h (OR= 3.34; 95%CI = 1.90–4.90; P < 0.001), and uncontrolled asthma (OR= 3.33; 95%CI = 2.50–5.05; P < 0.001). Predictors for hospitalization were old age (OR = 1.11; 95%CI = 1.09–2.11; P < 0.001), uncontrolled asthma (OR = 2.34; 95%CI = 2.01–4.40; P < 0.001), PEFR after 1 h (OR= 4.44; 95%CI= 3.24–7.68; P < 0.001), and SO2 <90% at baseline (OR= 5.67; 95%CI= 3.98–8.50; P < 0.001). Conclusions Severe asthma exacerbations can be predicted by old age, previous history of mechanical ventilation, obstructive sleep apnea, overuse of SABA, uncontrolled asthma, moderate to severe depression, eosinophilia, SO2 <90%, and low peak expiratory flow rates.

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Over-prescription of short-acting β₂-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study

Cited by 9 publications

References 49 publications

Overprescription of short‐acting β₂‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Overprescription of short‐acting β₂‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Over-the-counter use of short-acting beta-2 agonists: a systematic review

Acute severe asthma in emergency department: clinical characteristics, risk factors, and predictors for poor outcome

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Over-prescription of short-acting β2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study

Cited by 9 publications

References 49 publications

Overprescription of short‐acting β2‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Overprescription of short‐acting β2‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Over-the-counter use of short-acting beta-2 agonists: a systematic review

Acute severe asthma in emergency department: clinical characteristics, risk factors, and predictors for poor outcome

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Over-prescription of short-acting β₂-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study

Overprescription of short‐acting β₂‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study

Overprescription of short‐acting β₂‐agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study