Sponsored | Study confirms dangers of overusing asthma reliever pumps

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An alarming number of South Africans still die from asthma every year and the results of the SABINA III asthma study provide insights into why. The study reviewed local SABA prescription patterns among asthma patients. The results confirm over-prescription and over-the-counter purchase of the blue reliever pump to be widespread.

Despite the new approach to managing asthma, and the revised treatment guidelines in place, over-reliance on the blue SABA reliever pump regrettably remains unchanged. According to Professor Ismail Kalla, Pulmonologist, Head of Department - Internal Medicine, University of Witwatersrand, the significant overuse of the blue SABA reliever pump is a serious problem for South African asthma patients.

Prof Kalla adds that for decades asthmatic patients have been overusing their blue SABA symptom-reliever inhaler (which provides rapid and temporary relief) and underusing their anti-inflammatory maintenance medication. Many patients feel dependent on their SABA blue inhaler, mistakenly believing this to be the best way to control their symptoms.

“In line with the new global, and locally endorsed asthma treatment guidelines, we no longer prescribe SABA blue reliever inhalers alone as the preferred reliever therapy for mild asthma. Instead, we recommend the use of a low-dose inhaled corticosteroid (ICS)-formoterol therapy as needed, regardless of asthma disease severity.¹ This combination inhaler contains an anti-inflammatory agent which reduces inflammation of the airways and provides controlled relief.”

Despite the new way of treating asthma, the SABINA III results indicate a slow uptake of the new guidelines. Nearly 75% of the study patients used more than three SABA canisters in the previous 12 months and over 55% were prescribed more than 10 SABA canisters.

 “These figures are extremely concerning, as there is increasing evidence that SABA overuse, and in particular the use of more than three pumps a year, is associated with an increased risk of asthma attacks, hospitalisations and death^2,3,” explains Prof Kalla.^4,5, “Patients who are using this many blue pumps in a year should speak to their doctor immediately, to re-examine and revise their asthma treatment plan.”

Prof Kalla goes on to explain that chronic control relies on anti-inflammatory maintenance⁶ and this applies to all asthma patients - whether their illness has been classified as mild, moderate, or severe⁶. He adds that the approach to treatment and management of asthma is almost identical and reducing inflammation is at the heart of it⁷.

“What’s more, patients with mild asthma must recognise that their disease severity doesn’t preclude them from having an asthma attack^8,4. The risk is equally as high regardless of disease severity, adherence to treatment, or level of control^{5, 9, 10},” warns Prof Kalla.  

When it comes to childhood asthma the same treatment recommendations apply. Moreover, mild asthma is more frequent, symptomatic, and less controlled in children than in adults^11,12. But, as with adults, everything boils down to reducing inflammation and the overuse of their SABA inhaler also increases their risk of an attack. If inflammation and swelling are not treated, the airway walls may thicken permanently over time, preventing them from working efficiently.

“While there’s no cure for asthma it can be controlled and it’s important that asthmatics partner with their doctor to develop a solid asthma treatment plan that prioritises reducing inflammation safely. If you reduce your inflammation, you reduce your risks,” says Prof Kalla.

Asthma patients can assess their levels of over-reliance through AstraZeneca’s digital assessment tool, known as the Reliever Reliance Test. This evidence-based questionnaire empowers patients to assess their over-reliance on their blue reliever inhaler, SABA¹³ , by answering five short questions. If the results indicate over-reliance, that information can facilitate conversations with their healthcare professional about asthma management.

“Recognising that the use of a SABA blue inhaler to control asthma symptoms increases the risk of asthma attacks^14,4,5 – action to correct asthmatic compliance has never been more important,” concludes Kalla.

For more information about the Break Over-Reliance campaign and to take the Reliever Reliance Test, visit: https://bit.ly/TestForOverReliance

References:

1. Global strategy for Asthma Management and prevention. Global initiative for Asthma (GINA)2021. Available from https://ginasthma.org/wp-content uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf. Accessed August 2021.
2. Nwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: A nationwide cohort study of the global SABINA programme. Eur Respir J 2020;55(4):1901872. https://doi.org/10.1183%2F13993003.01872-2019
3. Bloom CI, Cabrera C, Arnetorp S, et al. Asthma-related health outcomes associated with short-acting β2-agonist inhaler use: An observational UK study as part of the SABINA Global Program. Adv Ther 2020;37(10):4190-4208.
4. Price D et al. NPJ Prim Care Respir Med. 2014;24:14009.
5. Papi A et al. J Allergy Clin Immunol Pract. 2018;6:1989-1998.
6. P.M. O Byrne. How much is too much? The treatment of mild asthma. EUR RESPIR J. 2007(30):403-406.
7. Global strategy for Asthma Management and prevention. Global initiative for Asthma (GINA)2021. Available from https://ginasthma.org/wp-content uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf. Accessed August 2021.
8. Papi A et al. J Allergy Clin Immunol Pract. 2018;6:1989-1998.
9. Price D et al. NPJ Prim Care Respir Med. 2014;24:14009.

10.  Fitzgerald J, Branes J, Ghipps E, et al. The burden of exacerbations in mild asthma: a systematic review. ERJ Open Res. 2020;6:00359-2019.

11.  Dusser D, Montani D, Chanez P, et al. Mild asthma: an expert review on epidemiology, clinical characteristics and treatment recommendations. Allergy.2007;62:591–604.

12.  O'Byrne. Daily inhaled corticosteroid treatment should be prescribed for mild persistent asthma. Am J Respir crit care med. 2005;172:410-416.

13.  International Primary Care Respiratory Group. Blue Reliever Reliance Test. Available at: https://www.ipcrg.org/resources/search-resources/blue-reliever-reliance-test-english [Last accessed: July 2020]

14.  The Global Asthma Report 2018. http://globalasthmareport.org/Global%20 Asthma%20Report%202018.pdf (accessed 26 October 2022)

Activity no : ZA- 4436   |   Expiry Date : September 2025

This post and content is sponsored, written and provided by AstraZeneca.