Abstract
ObjectiveUse of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage.MethodsData used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA.ResultsA weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector.ConclusionOral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.
Highlights
Asthma affects an estimated 300 million people worldwide [1] and was ranked the 15th most important disorder in the world in terms of extent and duration of disability [2]
Logistic regression models showed that there was a higher odds of oral short-acting beta-agonist (SABA) usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector
Principle management of asthma is well established and numerous clinical practice guidelines recommend the use of inhaled short-acting beta-agonist (SABA) as a reliever for acute asthma symptoms and early initiation of low dose inhaled corticosteroid (ICS) [1, 3,4,5,6]
Summary
Asthma affects an estimated 300 million people worldwide [1] and was ranked the 15th most important disorder in the world in terms of extent and duration of disability [2]. Principle management of asthma is well established and numerous clinical practice guidelines recommend the use of inhaled short-acting beta-agonist (SABA) as a reliever for acute asthma symptoms and early initiation of low dose inhaled corticosteroid (ICS) [1, 3,4,5,6]. Numerous clinical trials have shown that oral SABA requires higher doses to produce similar efficacy as the inhaled form, leading to more adverse effects such as tachycardia, hyperactivity, decreased oxygen saturation and tremors [7,8,9]. In a review for possible deletion of oral SABA from the World Health Organisation (WHO) Model of Essential Medicines List (EML) in 2010, it was concluded that the oral dosage forms would only be considered in the absence of the inhaled alternatives as a result of affordability issue of salbutamol inhalers [10, 11]. A study on asthma prescribing preferences among 226 clinicians in Malaysia in 2005, found that over 50% of doctors would prescribe oral SABA as the first line of treatment; the top reasons given were cost and patients’ reluctance to use inhaled salbutamol [16]
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