Perceptions, attitudes, and behaviors of asthma patients towards the use of short-acting β2-agonists: A systematic review

Abstract

Background Short-acting β2-agonists (SABA), the most potent and rapid-acting relievers are commonly used to provide quick relief of asthma symptoms. However, there is an increasing concern regarding the misuse of SABA medicines. Objective This qualitative systematic review aims to determine, evaluate, and summarize the perceptions, attitudes, and behaviors towards the use of SABA from the patients’ perspectives. Methods The databases searched included PubMed, Scopus, PsycINFO, CINAHL, and Cochrane database. Original research articles reporting the perceptions, attitudes, or behaviors of asthma patients towards the use of SABA, which was available as full text, published in the English language between the year 2000 and February 2023 were included in the review. Commentaries, letters to editor, review articles, and conference proceedings were excluded. Results A total of five articles were included. Six overarching themes were obtained: (1) perceptions on health status; (2) perceptions and attitudes towards the impact of asthma; (3) perceptions towards asthma control; (4) perceptions towards asthma knowledge; (5) risk perceptions; (6) perceptions, attitudes, and behaviors towards the use of SABA. Conclusion Despite the fact that SABA could rapidly alleviate asthma symptoms, SABA over-users were less likely to describe their health status and asthma control as ‘excellent’. Most SABA over-users did not know that frequent SABA usage would worsen their asthma control, and they exhibited psychological linkage towards the use of SABA. Collaborative efforts between policymakers, healthcare professionals and patients are warranted to reconstruct SABA prescribing practice and usage.

The Association Between Short-Acting β2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia

“…In other countries, physician over-prescribing behaviours have been attributed to variability in thresholds for acceptable SABA use, questioning of the risk of morbidity and mortality with high SABA use, and a consideration that asthma guidelines are too ‘stringent’ [ 12 ]. Overuse of SABA by patients has been linked to a lack of knowledge that frequent usage would worsen asthma control, and strong psychological links to use of SABA, due to immediate relieving effects [ 22 ]. SABA overuse in Australia may also reflect specific peculiarities of the healthcare system and reimbursement practices [ 23 , 24 ].…”

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

“…In many studies that were included in the review, SABA overuse was associated with underuse of preventers [ 51 , 52 ]. The results of several studies included in this review indicated that asthma patients may tend to over-rely on SABA due to inability to cope with the situation, social challenges, fear of symptoms, and the belief that they cannot manage their condition without SABA inhalers [ 1 , 17 , 53 , 54 ]. These results match expert opinion, or results of research not included in this review (i.e., studies that did not capture prevalence of SABA OTC use or overuse) [ 50 , 51 ].…”

“…The statistical data were included, where available, to indicate the magnitude of the key findings, it was not used in the data synthesis process. As a result, handling of any missing summary statistics was not needed in this systematic review [ 17 ].…”

“…The overuse of SABA in certain countries may, in part, be due to non-prescription-based accessibility such as Australia, Italy and Spain, where salbutamol inhalers are available as non-prescription medicines [ 14 – 16 ]. Because of this, some patients who believe their symptoms are controllable through use of SABAs alone may rely on these inhalers to manage the condition in these countries [ 17 ]. This overuse is also perpetuated by the belief that SABAs provide faster relief, especially when compared to inhaled corticosteroids which do not immediately address symptoms and may take a few weeks for effect [ 14 , 17 , 18 ].…”

“…Because of this, some patients who believe their symptoms are controllable through use of SABAs alone may rely on these inhalers to manage the condition in these countries [ 17 ]. This overuse is also perpetuated by the belief that SABAs provide faster relief, especially when compared to inhaled corticosteroids which do not immediately address symptoms and may take a few weeks for effect [ 14 , 17 , 18 ]. For instance, in Australia, researchers suggest that patients with mild asthma symptoms may choose not to seek medical attention, given they can access over-the-counter salbutamol inhaler relieves for their symptoms [ 19 ].…”