The Association Between Short-Acting β2-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia

David Price; Christine Jenkins; Kerry Hancock; Rebecca Vella; Florian Heraud; Porsche Le Cheng; Ruth Murray; Maarten Beekman; Sinthia Bosnic-Anticevich; Fabio Botini; Victoria Carter; Angelina Catanzariti; Joe Doan; Kirsty Fletton; Ata Kichkin; Thao Le; Chantal Le Lievre; Chi Ming Lau; Dominique Novic; John Pakos; Kanchanamala Ranasinghe; Alexander Roussos; Josephine Samuel-King; Anita Sharma; Deb Stewart; Bruce Willet; Eric Bateman; OPCA Improving Asthma Outcomes in Australia Research Group

doi:10.1007/s12325-023-02746-0

The Association Between Short-Acting β₂-Agonist Over-Prescription, and Patient-Reported Acquisition and Use on Asthma Control and Exacerbations: Data from Australia

Adv Ther. 2024 Mar;41(3):1262-1283. doi: 10.1007/s12325-023-02746-0. Epub 2024 Feb 4.

Authors

David Price^{1

2

3

4}, Christine Jenkins⁵, Kerry Hancock^{6

7}, Rebecca Vella⁸, Florian Heraud⁹, Porsche Le Cheng⁸, Ruth Murray¹⁰, Maarten Beekman¹¹, Sinthia Bosnic-Anticevich^{12

13}, Fabio Botini⁸, Victoria Carter¹⁰, Angelina Catanzariti¹⁴, Joe Doan¹⁵, Kirsty Fletton¹⁰, Ata Kichkin¹⁶, Thao Le¹⁷, Chantal Le Lievre⁸, Chi Ming Lau¹⁸, Dominique Novic¹⁹, John Pakos²⁰, Kanchanamala Ranasinghe^{21

22}, Alexander Roussos⁸, Josephine Samuel-King²³, Anita Sharma²⁴, Deb Stewart²⁵, Bruce Willet²⁶, Eric Bateman²⁷; OPCA Improving Asthma Outcomes in Australia Research Group

Collaborators

OPCA Improving Asthma Outcomes in Australia Research Group:
Rob Campbell, Ying Liu, Nicole O'Sullivan, Ondrej Rejda, Lisa Sugg, Steph James, Kiran Dhillon, Sophie Jones

Affiliations

¹ Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK. [email protected].
² Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06-76, Midview City, 573969, Singapore. [email protected].
³ Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK. [email protected].
⁴ Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia. [email protected].
⁵ Thoracic Physician Concord Hospital, Head Respiratory Trials, George Institute, University of Sydney, Sydney, Australia.
⁶ Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, VIC, 3010, Australia.
⁷ RACGP Resp Medicine SIG, 100 Wellington Parade, East Melbourne, Melbourne, VIC, 3002, Australia.
⁸ Optimum Patient Care Australia, 27 Creek St, Brisbane, QLD, 4000, Australia.
⁹ Queensland Health, Brisbane, QLD, Australia.
¹⁰ Optimum Patient Care, 5 Coles Lane, Oakington, CB24 3BA, Cambridgeshire, UK.
¹¹ BioPharmaceuticals Medical and Regional Medical Director for International, The Hague, The Netherlands.
¹² Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
¹³ Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, MSW, 2037, Australia.
¹⁴ AstraZeneca Biopharmaceuticals Medical, Medical Affairs, 66 Talavera Road, Macquarie Park, NSW, Australia.
¹⁵ HealthPlus Medical Centre, 28/26 Belgrave St, Kogarah, NSW, 2217, Australia.
¹⁶ Blue Shield Family General Practice, Kogarah, NSW, 2217, Australia.
¹⁷ Medical Education, and Events Management Pte Ltd, Singapore, Singapore.
¹⁸ Toukley Family Practice, 37-41 Canton Beach Road, Toukley, NSW, 2263, Australia.
¹⁹ Redlands Medical Centre, 189 Vienna Rd, Alexandra Hills, 4161, Australia.
²⁰ Woodcroft Medical Centre, Woodcroft, SA, 5162, Australia.
²¹ School of Medicine, Griffith University, Gold Coast, Australia.
²² Cannon Hill Family Doctors, 17/1177 Wynnum Rd, Cannon Hill, QLD, 4170, Australia.
²³ Ripponlea Medical Centre, Ripponlea, VIC, 3185, Australia.
²⁴ Platinum Medical Centre, 18 Banfield St, Chermside, QLD, 4032, Australia.
²⁵ School of Medicine, University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia.
²⁶ Victoria Point Surgery, Brisbane, QLD, 4165, Australia.
²⁷ Department of Medicine, University of Cape Town, and University Cape Town Lung Institute, Cape Town, South Africa.

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.

Keywords: Asthma management; Asthma outcomes; Over-the-counter medication; Prescription patterns; Short-acting β2-agonists.

Publication types

Observational Study

MeSH terms

Administration, Inhalation
Adrenergic beta-2 Receptor Agonists* / administration & dosage
Asthma* / diagnosis
Australia
Cross-Sectional Studies
Humans
Inappropriate Prescribing*
Patient Reported Outcome Measures

Substances

Adrenergic beta-2 Receptor Agonists