Prevalence of overuse of short-acting beta-2 agonists (SABA) and associated factors among patients with asthma in Germany

Heinrich Worth,Karel Kostev,Ingo Mokros,Andrea Schneider,Carl-Peter Criée,Claus F Vogelmeier,Eva-Maria Becker,Peter Kardos

doi:10.1186/s12931-021-01701-3

Abstract

BackgroundOveruse of short-acting beta-2 agonists (SABA), which do not treat the underlying inflammation of asthma, is linked to poor clinical outcomes such as increased exacerbation risk. This study, as part of the SABINA program, estimated the prevalence of SABA overuse and associated variables in outpatients in Germany.MethodsThis retrospective study used anonymized electronic healthcare data from the Disease Analyzer database (IQVIA). A total of 15,640 patients aged ≥ 12 years with asthma who received ≥ 1 SABA prescription(s) between July 2017 and June 2018 in 924 general physician and 22 pneumologist (PN) practices were included. SABA overuse was defined as ≥ 3 prescribed inhalers (~ 200 puffs each) during the study period. The associations between SABA overuse and physician specialty, Global Initiative for Asthma (GINA) steps (based on asthma medications), age, sex, and inhaled corticosteroid (ICS)/long-acting beta agonist (LABA) use were estimated using multivariable regression for patients with probable moderate (GINA step 2) and probable severe (GINA steps 3–5) asthma.ResultsAnnually, 36% of all patients (GINA steps 1–5) in general and 38% in PN practices received ≥ 3 SABA inhalers. The risk of SABA overuse was 14% higher in patients treated by a general practitioner vs. a PN; 34% and 85% higher in GINA steps 4 and 5, respectively, vs. GINA step 3; and 40% higher in male vs. female patients.ConclusionsSABA overuse is prevalent among patients with asthma across all GINA steps in Germany, which may indicate suboptimal asthma control. Further studies are needed to investigate the reasons behind SABA overuse.

Highlights

Overuse of short-acting beta-2 agonists (SABA), which do not treat the underlying inflammation of asthma, is linked to poor clinical outcomes such as increased exacerbation risk
The proportion of patients with SABA overuse increased with Global Initiative for Asthma (GINA) step (52% seen by General practitioner (GP) and 54% seen by PNs)
Summary of main findings This German retrospective study of 15,640 patients with asthma showed that the proportion of patients with SABA overuse/increased use was very high, especially among patients treated by GPs, patients classified as being at GINA step 4 or 5, and male patients

Summary

Introduction

Overuse of short-acting beta-2 agonists (SABA), which do not treat the underlying inflammation of asthma, is linked to poor clinical outcomes such as increased exacerbation risk. This study, as part of the SABINA pro‐ gram, estimated the prevalence of SABA overuse and associated variables in outpatients in Germany. The lifetime prevalence of asthma in adults in Germany is approximately 6–9% [1, 2]. The prevalence varies considerably between federal states in Germany and is known to be higher in adult women than in men and in people with a low level of education [2]. By definition, when adequate control of asthma cannot be achieved by high-dose treatment with inhaled. One of the known problems in asthma patient care is the overuse of inhaled short-acting beta-2 agonists (SABA) [4, 5]. If symptoms and activity limitation due to asthma are present it is classified as uncontrolled asthma [7]

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