Clinicians are “shockingly” complacent about excessive SABA use

Clinicians are complacent about SABA overuse, ignoring evidence that excessive prescribing can cause asthma deaths, a new study in npj Primary Care Respiratory Medicine has revealed.

Researchers who interviewed 21 clinicians from primary and secondary care, including 13 who were asthma experts, found wide variations in how the clinicians defined excessive SABA use. The threshold for acceptable SABA use varied between 0.5 inhalers (100 doses) and 12 inhalers (2400 doses) a year.

Opinions on the duration of time needed to determine SABA overuse varied between daily and weekly doses and/or monthly inhaler count.

Despite current evidence some experts questioned the risk of morbidity and mortality associated with high SABA use.

UK asthma guidelines state that using SABA at least three times a week is a marker for potentially poor control and a predictor of future risk of asthma attacks and death and The National Review of Asthma Deaths “Why asthma still kills,” (NRAD) recommended that prescription of more than one SABA per month should trigger an asthma review.

The authors comment: “Despite a large body of evidence, there was shocking complacency about SABA over-use and a disregard of current evidence. Unless attitudes can be challenged and changed, it is difficult to see how asthma deaths can be reduced; certainly new guidelines are not the answer.”

Dr Noel Baxter, PCRS-UK Chair says: “Primary health care remains complacent about the ‘overuse of SABA’ it is suggested by this qualitative review of health professional views. The evidence is there but the message isn't getting through. PCRS-UK as a member of the International Primary Care respiratory Group is working with other countries to change this healthcare perspective through a social movement perspective. Look out for more thinking and materials coming from the UK Asthma Right Care team over the next few months and see what we have produced at our next conference so you can take them away and continue the movement."

To make sure you are up to date:

• Attend a refresher session on the lessons learned from NRAD at the PCRS-UK annual conference Building confidence in a changing world 28-29 September, Telford International Centre.
• Read this PCRS-UK consensus statement on key aspects of the diagnosis, management and monitoring of asthma to provide clarity for primary care clinicians faced with conflicting national guidelines.