Characteristics of patients with asthma overprescribed short-acting beta-agonist (SABA) reliever inhalers stratified by blood eosinophil count in North East London: a cross-sectional observational study

Pfeffer, P; Hajmohammadi, H; Cole, J; Griffiths, C; Hull, S; De Simoni, A

Journal article

Characteristics of patients with asthma overprescribed short-acting beta-agonist (SABA) reliever inhalers stratified by blood eosinophil count in North East London: a cross-sectional observational study

Abstract:: BACKGROUND: Over-prescription of short-acting beta-agonist (SABA) inhalers and blood eosinophil count have strong associations with exacerbation risk in asthma. However, in our recent publication only a minority of SABA-overprescribed patients (≥6 inhalers in 12 months) were eosinophilic (≥0.3x109 cells/L). AIM: To compare the characteristics of eosinophilic and non-eosinophilic SABA over-prescribed patients, and identify latent classes using clinical variables available in primary care. DESIGN & SETTING: Cross-sectional analysis of asthmatic patients in North East London using primary care electronic health record data. METHOD: Unadjusted and adjusted multi-variate regression models and latent class analysis. RESULTS: Eosinophilia was significantly less likely in female patients, those with multiple mental health comorbidities and those with SABA on repeat prescription. Latent class analysis identified 3 classes of SABA over-prescribed patients representing those with classical Uncontrolled Asthma (oral-steroid requiring exacerbations, step 2-3 asthma medications, high probability of being eosinophilic), Mild Asthma (low exacerbation frequency, low asthma medication step, low probability of being eosinophilic), and Difficult Asthma (high exacerbation frequency despite high-strength preventer inhalers, low probability of being eosinophilic). The Mild Asthma class was the largest. CONCLUSION: Many patients being over-prescribed SABA are non-eosinophilic with a low exacerbation frequency suggesting disproportionately high SABA prescription compared to other asthma control markers. Potential reasons for high SABA prescription in these patients include repeat prescription (being dispensed but not taken) and use of SABA for non-asthma breathlessness (eg, breathing pattern disorders with anxiety). Further research is needed into management of SABA overuse in patients without other markers of uncontrolled asthma

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Pfeffer, P., Hajmohammadi, H., Cole, J., Griffiths, C., Hull, S., & De Simoni, A. (2023). Characteristics of patients with asthma overprescribed short-acting beta-agonist (SABA) reliever inhalers stratified by blood eosinophil count in North East London: a cross-sectional observational study. British Journal of General Practice Open, 7(2), BJGPO.2023.0020-BJGPO.2023.0020.

MLA Style

Pfeffer, P, et al. “Characteristics of Patients with Asthma Overprescribed Short-Acting Beta-Agonist (SABA) Reliever Inhalers Stratified by Blood Eosinophil Count in North East London: a Cross-Sectional Observational Study.” British Journal of General Practice Open, vol. 7, no. 2, 2023, pp. BJGPO.2023.0020-BJGPO.2023.0020.

Chicago Style

Pfeffer, P, H Hajmohammadi, J Cole, C Griffiths, S Hull, and A De Simoni. 2023. “Characteristics of Patients with Asthma Overprescribed Short-Acting Beta-Agonist (SABA) Reliever Inhalers Stratified by Blood Eosinophil Count in North East London: a Cross-Sectional Observational Study.” British Journal of General Practice Open 7 (2): BJGPO.2023.0020-BJGPO.2023.0020.
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