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.
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.
| Original language | English |
|---|---|
| Number of pages | 22 |
| Journal | Advances in Therapy |
| Early online date | 4 Feb 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 4 Feb 2024 |
Bibliographical note
AcknowledgementsAuthor Contribution
The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas. The first draft of the manuscript was written by Dr. Rebecca Vella and all authors took part in drafting, revising or critically reviewing the article. All authors gave final approval of the version to be published. All authors have agreed on the journal to which the article has been submitted and agree to be accountable for all aspects of the work. All authors have given approval for the submission of
this article. The authors received no direct compensation related to the development of the manuscript.
Funding
This study was conducted by Optimum Patient Care Australia (OPCA) and was partially funded by AstraZeneca and Optimum Patient Care Australia (OPCA). The cost of the Open Access Fees were provided by AstraZeneca. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.
Data Availability Statement
Data availabilityThe authors do not have permission to give public access to the study dataset. However, researchers may request access to OPCRDA data for their own purposes. Access to OPCRDA can be made via the OPCRDA website (https://optimumpatientcare.org.au/contact-us/) or via the enquiries email audit@optimumpatientcare.org.
Keywords
- Short-acting β2-agonists
- Asthma management
- Over-the-counter medication
- Prescription patterns
- Asthma outcomes