More than a quarter of people with asthma are over-using rescue inhalers - putting them at increased risk of severe attacks and hospitalisation, new research has found, highlighting the need to provide pharmacists and GPs with 'the right tools' to support patients to reduce the problem.
'There is an ongoing major burden of inappropriate and dangerous rescue inhaler overuse in asthma,' warned Paul Pfeffer, consultant respiratory physician at Barts Health NHS Trust and co-author of the research paper Reducing SABA overprescribing in asthma: lessons from a Quality Improvement prescribing project in East London.
Some GP practices are also overprescribing rescue inhalers - intended for rapid relief of asthma symptoms - to as many as 60% of their asthma patients, researchers at Queen Mary University of London found.
'Overuse of these inhalers is linked to an increased risk of hospital admissions and severe asthma attacks,' the research university said.
Asthma is a common lung condition that affects 5.4 million people in the UK and can lead to symptoms such as coughing, wheezing or feeling breathless.
It is 'best controlled' by regular use of a corticosteroid inhaler, which prevents symptoms from occurring, the university said, but people with asthma may also use rescue, or SABA - short-acting beta-agonist - inhalers to quickly relieve symptoms when needed.
Research has shown it's 'common' for people with asthma to overuse SABA inhalers (defined as six or more prescriptions per year), the university said, 'and that relying on SABA for relief instead of using corticosteroids to prevent symptoms is linked to poor asthma control and an increased risk of severe asthma attacks and hospital admissions.'
In East London, where Queen Mary University of London is based, hospitalisation for acute asthma is 14% above the London average, the university said.
'Given the impact this has on our community, researchers at Queen Mary’s Clinical Effectiveness Group analysed over 700,000 anonymised patient records at 117 GP practices in East London.
'They found that 26% of patients with asthma are overprescribed SABA inhalers. Out of this group, a quarter of those were also underusing preventative (corticosteroid) inhalers, raising concerns about inadequate prevention in a group of people with significant asthma.'
Anna De Simoni, lead author of the research paper and GP and clinical lecturer in primary care at Queen Mary University of London, said there is 'significant room for improvement,' and working with patients to improve regular use of preventative inhalers 'should be central to reducing asthma-related hospital admissions.'
She said: 'We calculated that supporting patients who use more than 12 SABA inhalers per year to reduce their use to 4-12 could result in 70% fewer asthma-related hospital admissions in that group.'
Ms De Simoni highlighted 'a need to provide GPs and pharmacists with the right tools to support patients to do this' and said that 'in the next phase of this research programme, we plan to provide practices with tools to support the identification and management of high-risk patients based on prescribing records.'
The study also revealed that prescribing varies significantly between GP practices, with some overprescribing to 6% of their asthma patients and some overprescribing to as many as 60%.
'Further analysis of the variation revealed that overprescribing was strongly linked to repeat dispensing, where prescriptions are issued automatically by community pharmacists,' the university said.
Mr Pfeffer commented: 'Our paper highlights the complexity of the problem with multiple reasons patients are overprescribed SABA inhalers. The findings are a call for more detailed research into interventions to reduce inappropriate SABA overuse in different patient groups.'
The National Review of Asthma Deaths in 2014 found evidence of overuse of, or over-reliance on, reliever inhalers in people who died of asthma. Electronic surveillance of prescribing in primary care was recommended as a matter of urgency.
Digital interventions such as ‘smart’ inhalers and text message prompts can improve asthma medication adherence by 15% and may cut the risk of asthma attacks by half, research published this month has suggested.