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Price D, Jenkins C, Hancock K, Vella R, Heraud F, Le Cheng P, Murray R, Beekman M, Bosnic-Anticevich S, Botini F, Carter V, Catanzariti A, Doan J, Fletton K, Kichkin A, Le T, Le Lievre C, Lau CM, Novic D, Pakos J, Ranasinghe K, Roussos A, Samuel-King J, Sharma A, Stewart D, Willet B, Bateman E. The Association Between Short-Acting β 2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia. Adv Ther 2024; 41:1262-1283. [PMID: 38310584 PMCID: PMC10879376 DOI: 10.1007/s12325-023-02746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024]
Abstract
INTRODUCTION In Australia, short-acting β2-agonists (SABA) are available both over the counter (OTC) and on prescription. This ease of access may impact SABA use in the Australian population. Our aim was to assess patterns and outcome associations of prescribed, acquired OTC and reported use of SABA by Australians with asthma. METHODS This was a cross-sectional study, using data derived from primary care electronic medical records (EMRs) and patient completed questionnaires within Optimum Patient Care Research Database Australia (OPCRDA). A total of 720 individuals aged ≥ 12 years with an asthma diagnosis in their EMRs and receiving asthma therapy were included. The annual number of SABA inhalers authorised on prescription, acquired OTC and reported, and the association with self-reported exacerbations and asthma control were investigated. RESULTS 92.9% (n = 380/409) of individuals issued with SABA prescription were authorised ≥ 3 inhalers annually, although this differed from self-reported usage. Of individuals reporting SABA use (n = 546) in the last 12 months, 37.0% reported using ≥ 3 inhalers. These patients who reported SABA overuse experienced 2.52 (95% confidence interval [CI] 1.73-3.70) times more severe exacerbations and were 4.51 times (95% CI 3.13-6.55) more likely to have poor asthma control than those who reported using 1-2 SABA inhalers. Patients who did not receive SABA on prescription (43.2%; n = 311/720) also experienced 2.71 (95% CI 1.07-7.26) times more severe exacerbations than those prescribed 1-2 inhalers. Of these patients, 38.9% reported using OTC SABA and other prescription medications, 26.4% reported using SABA OTC as their only asthma medication, 13.2% were prescribed other therapies but not SABA OTC and 14.5% were not using any medication. CONCLUSION Both self-reported SABA overuse and zero SABA prescriptions were associated with poor asthma outcomes. The disconnect between prescribing authorisation, OTC availability and actual use, make it difficult for clinicians to quantify SABA use.
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Affiliation(s)
- David Price
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK.
- Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore.
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia.
| | - Christine Jenkins
- Thoracic Physician Concord Hospital, Head Respiratory Trials, George Institute, University of Sydney, Sydney, Australia
| | - Kerry Hancock
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, VIC, 3010, Australia
- RACGP Resp Medicine SIG, 100 Wellington Parade, East Melbourne, Melbourne, VIC, 3002, Australia
| | - Rebecca Vella
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | | | - Porsche Le Cheng
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | - Ruth Murray
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK
| | - Maarten Beekman
- BioPharmaceuticals Medical and Regional Medical Director for International, The Hague, The Netherlands
| | - Sinthia Bosnic-Anticevich
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, MSW, 2037, Australia
| | - Fabio Botini
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | - Victoria Carter
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK
| | - Angelina Catanzariti
- AstraZeneca Biopharmaceuticals Medical, Medical Affairs, 66 Talavera Road, Macquarie Park, NSW, Australia
| | - Joe Doan
- HealthPlus Medical Centre, 28/26 Belgrave St, Kogarah, NSW, 2217, Australia
| | - Kirsty Fletton
- Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK
| | - Ata Kichkin
- Blue Shield Family General Practice, Kogarah, NSW, 2217, Australia
| | - Thao Le
- Medical Education, and Events Management Pte Ltd, Singapore, Singapore
| | - Chantal Le Lievre
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | - Chi Ming Lau
- Toukley Family Practice, 37-41 Canton Beach Road, Toukley, NSW, 2263, Australia
| | - Dominique Novic
- Redlands Medical Centre, 189 Vienna Rd, Alexandra Hills, 4161, Australia
| | - John Pakos
- Woodcroft Medical Centre, Woodcroft, SA, 5162, Australia
| | - Kanchanamala Ranasinghe
- School of Medicine, Griffith University, Gold Coast, Australia
- Cannon Hill Family Doctors, 17/1177 Wynnum Rd, Cannon Hill, QLD, 4170, Australia
| | - Alexander Roussos
- Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia
| | | | - Anita Sharma
- Platinum Medical Centre, 18 Banfield St, Chermside, QLD, 4032, Australia
| | - Deb Stewart
- School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia
| | - Bruce Willet
- Victoria Point Surgery, Brisbane, QLD, 4165, Australia
| | - Eric Bateman
- Department of Medicine, University of Cape Town, and University Cape Town Lung Institute, Cape Town, South Africa
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Wang L, Zhou L, Zheng P, Mao Z, Liu H. Mild asthma is not mild: risk factors and predictive biomarkers for severe acute exacerbations and progression in mild asthma. Expert Rev Respir Med 2023; 17:1261-1271. [PMID: 38315090 DOI: 10.1080/17476348.2024.2314535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Asthma is a common chronic respiratory disease characterized by chronic airway inflammation, airway hyperresponsiveness, reversible airflow limitation, and airway remodeling. Mild asthma is the most common type of asthma, but it is the most neglected. Sometimes mild asthma can lead to acute severe exacerbations or even death. AREAS COVERED This article reviews the epidemiology, risk factors, and possible predictors of acute severe exacerbations and disease progression in mild asthma to improve the understanding of mild asthma and its severe acute exacerbations and progression. EXPERT OPINION There is a necessity to improve asthma patient categorization and redefine mild asthma's concept to heighten patient and physician attention. Identifying mild asthma patients that are highly vulnerable to severe acute exacerbations and researching the mechanisms are future prioritizations.
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Affiliation(s)
- Lingling Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Zhou
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pengdou Zheng
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenyu Mao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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