‘Extreme’ SABA overuse seen with pharmacy OTC inhalers


By Michael Woodhead

15 Aug 2019

Lax rules that allow people to buy asthma reliever inhalers in retail pharmacies without medical supervision is contributing to widespread overuse of short-acting beta-agonists (SABA), Australian research suggests.

A survey of 412 people who bought a SABA inhaler over the counter from a retail pharmacy found that 289 (70%) were overusers, as defined by inhaler use more than twice per week in the past four weeks.

Other issues of concern from the snapshot of asthma inhaler purchasers in NSW community pharmacies in 2017-2018 include the finding that 74% of SABA inhaler users reporting not using a preventer daily.

About one in four patients (25.9%) reported using their preventer on an ‘as needed’ basis, with most believing that they did not need to use their preventer regularly or being put off by side effects.

Researchers from the Woolcock Institute of Medical Research, and University of Sydney Medical School also found that almost one in five ( 18%) of patients buying a SABA inhaler did not have a doctor diagnosis of asthma.

Overall, 47% of the SABA inhaler buyers had uncontrolled asthma and 36% had partially controlled asthma, based on GINA-defined criteria. A higher proportion of SABA overusers had uncontrolled asthma compared to non-overusers (59% vs 15%).

When asked how often they used their SABA inhaler, 31% of buyers said they took 5-12 puffs per day and 6% used more than 12 puffs per day.

The study also revealed that SABA overusers were more likely to have moderate-severe rhinitis symptoms (81% vs 63%).

The researchers said urgent action was needed to address the extremely high rates of SABA overuse, which when combined with low rates of preventer use would contribute to poor asthma control.

“Perhaps the most significant finding of this research is that it identified people with asthma in the community who have poorly controlled asthma and without pharmacist’s intervention, may never be identified as problematic and in need of inhaled corticosteroid treatment,” they wrote in BMJ Open.

But rather than ban OTC inhaler sales and require patients to obtain them from a physician, the researchers suggest that  the problematic SABA overuse be seen as an opportunity for pharmacist intervention.

Community pharmacists are in a unique position “to be able to identify patients, with milder disease, who are experiencing poor control and not using preventer medication, by adopting the paradigm of treatable traits that can be identified in a pharmacy setting,” they wrote.

“We suggest that this be taken one step further, where pharmacists can begin to identify treatable factors that warrant oral steroid use and SABA overuse,” they added.

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