Over 60% of Dutch asthma patients report using sabas more than two times a week, which is associated with high exacerbation frequency
Epidemiology, diagnosis and monitoringIntroduction: Asthma control is still inadequate in daily clinical practice, despite the availability of effective treatment options. A marker for poor asthma control is short acting beta2-agonist (SABA) (over)use. Many patients appear to rely more on their SABA rather than their anti-inflammatory maintenance therapy (inhaled corticosteroids, ICS) and are thereby not treating the underlying inflammation and their asthma remains uncontrolled. To be able to optimally inform clinical decision making, more insight into SABA (over)use in the Netherlands is required.
Aim: To describe the differences in indicators of asthma symptoms and exacerbations within patients with reported SABA use either above or below the in guidelines recommended threshold of <3 times/week.
Methods:Data of the Dutch respondents from the European REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey was used [Price et al. Prim Care Respir. Med; 2014; 24; 14009]. This survey was a qualitative, online questionnaire-based survey, which included asthma patients aged 18-50 years with at least two prescriptions for their asthma in the past two years. SABA use was categorized into two groups: <3 or ≥3 times in the last week. Subsequently, differences in indicators of asthma symptoms and exacerbations were assessed, using the chi-square test.
Indicators of asthma symptoms included day-time symptoms, normal activities affected by symptoms and awakening at night, all during the 7 days preceding the survey. Indicators of exacerbations included the number of antibiotics and oral steroid courses needed due to worsening of asthma, the number of emergency department visits and overnight hospital stays due to asthma, all in the last 12 months.
Results: Of the 817 respondents, 20.0% (n=163) did not use SABA, 18.2% (n=149) used SABA 1 to 2 times (<3 SABA users) and 61.8% (n=505) used SABA ≥3 times (≥3 SABA users), in the last week. Indicators of asthma symptoms were found to be not significantly different for <3 SABA users vs ≥3 SABA users (P>0.05). Significant differences were found for all indicators of exacerbations (P<0.01). Of the <3 SABA users 43.6% (n=136) needed antibiotics and 23.4% (n=73) needed oral steroids, whereas 59.6% (n=301) of the ≥3 SABA users needed antibiotics and 46.7% (n=236) needed oral steroids in the last 12 months. Emergency departments were visited due to asthma by 3.2% (n=10) of the <3 SABA users and 17.2% (n=87) of the ≥3 SABA users, in the last 12 months. Overnight hospital stays due to asthma were reported by 1.3% (n=4) of the <3 SABA users and 9.9% (n=50) of the ≥3 SABA users.
Discussion: This data shows over 60% of respondents reported SABA use above the in guidelines recommended threshold of <3 times/week. Despite the absence of a difference in indicators of asthma symptoms, SABA overusers did more frequently have moderate or severe exacerbations. More effective interventions are needed to change behavior in healthcare providers and patients to reduce SABA (over)use.