Australians engaging in ‘high risk’ asthma practices

The University of Sydney study investigated the use of short-acting beta agonists (SABA) purchased from NSW pharmacies.
 
More than two thirds of the 412 questionnaires completed by people buying SABAs over the counter reported so-called ‘overuse’ of the medication, which, while potentially life-saving, can also be problematic when used long term.
 
A similar ratio of people did not use a preventer puffer regularly, while nearly one in five patients who bought a reliever without a prescription had not been diagnosed with asthma.
 
Dr Kerry Hancock, Chair of the RACGP Respiratory Medicine Specific Interests network, told newsGP the high prevalence of significant nasal symptoms in the SABA over-users, indicating the possible presence of allergic rhinitis, and the higher prevalence of depression, is of particular concern.
 
‘These are known risk factors for adverse outcomes, such as exacerbations and mortality, in people with asthma,’ she said.
 
‘Surprisingly, about 75% of these pharmacy attendees requesting over-the-counter SABAs had visited a doctor for their asthma in the past 12 months.
 
‘These patients are not “hidden” from general practice and therefore general practice has the opportunity to engage with these patients to reduce their risk of adverse outcomes.’
 
Senior author Professor Sinthia Bosnic-Anticevich said the study’s results demonstrate that concerns about asthma management are real, and as such believes SABA therapy should be carefully restricted to ‘as needed’ usage only.
 
‘We know that using your reliever too much is linked to poor asthma control, increased airway hyper-responsiveness, more asthma-related hospital admissions and, in extreme cases, death. What we really need to understand is why this is happening,’ she said.
 
‘The high proportion of reliever overuse and the low proportion of regular preventer use is in complete contrast to what we would hope to see. We absolutely don’t want to ask patients to withhold using their SABA if they need it, but we do need to solve the problem.
 
‘It is critical that we support patients and work with them and their doctors to ensure that asthma flare ups are prevented, and overuse of SABA is not the answer.’
 
According to the study’s authors, global asthma experts recently moved to officially label reliever-only use as a practice associated with high risk.
 
Australia is one of the few countries that allows over-the-counter sale of reliever puffers, but Dr Hancock does not believe regulatory change would improve asthma management.
 
‘Reliever medication needs to be readily accessible to the community – for example, in first-aid kits in schools and sporting facilities – and re-scheduling to Schedule 4 would preclude this,’ she said.
 
‘In my opinion, up-scheduling of salbutamol would not resolve the issue of inappropriate overuse of SABA … we need to develop strategies to enhance the links between general practice and our pharmacy colleagues to improve the management of these at-risk patients.’
 
Around one in 10 Australians have the respiratory condition and Professor Bosnic-Anticevich’s team is calling for more research into new methods for identifying uncontrolled asthma patients, as well as how to best refer them onto treatment plans that improve outcomes.
 
‘SABA overuse is very high, while preventer medication use remains low – a habit which can lead to poor outcomes and likely explains why only a quarter of over-the-counter purchasers reported well-controlled asthma,’ Professor Bosnic-Anticevich said.
 
‘When you consider that there are potentially tens of thousands of people using their medication like this, it suggests that a considerable proportion of Australians are experiencing wheezing, chest tightness and, worse still, asthma flare ups, due to uncontrolled disease.’

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