Overuse of short-acting beta-agonists (SABA) and risk factors among patients with asthma

Introduction: Overuse of SABA, which do not treat the underlying inflammation of asthma, is linked to poor clinical outcomes such as increased exacerbation risk. Aims: To estimate the prevalence of SABA overuse and potential risk factors among patients with asthma in Germany as part of the SABINA framework (Cabrera C, et al. ERJ. 2019). Methods: This retrospective study used anonymized electronic healthcare data from the IQVIA Disease Analyzer database. Patients (n=15,640) aged ≥12 years with asthma who received ≥1 SABA prescription between July 2017 and June 2018 in 924 general (GP) and 22 pneumologist (PN) practices were included. SABA overuse was defined as ≥3 prescribed inhalers (~200 puffs each) in the study period. The association between SABA overuse and physician specialty, GINA steps (based on asthma medications), age, sex, and ICS(/LABA) use was estimated using multivariate regression for patients with moderate (GINA step 2) and severe (GINA steps 3–5) asthma. Results: Mean annual number of prescribed SABA inhalers was 3.5 per patient, increasing from 2.9 to 4.9 inhalers in patients at GINA 2 and 5, respectively. Annually, 36% of all patients (GINA 1–5) in GP and 38% in PN practices received ≥3 SABA inhalers. SABA overuse risk was 16% higher in patients treated by a GP vs. PN, 33% and 83% higher in GINA 4 and 5, respectively, vs. GINA 3, and 39% higher in male vs. female patients. SABA overuse risk was higher in patients using ICS(/LABA) at GINA 3–5 vs. at GINA 2. Conclusions: In Germany, SABA overuse is prevalent among patients with asthma across all GINA steps which may indicate suboptimal asthma control. Further studies are needed to investigate the reasons behind the SABA overuse.