Over-prescription of short-acting β2-agonists and asthma management in the Gulf region: a multicountry observational study

Abstract

Background: The overuse of short-acting β2-agonists (SABA) is associated with poor asthma control. However, data on SABA use in the Gulf region are limited. Herein, we describe SABA prescription practices and clinical outcomes in patients with asthma from the Gulf cohort of the SABA use IN Asthma (SABINA) III study.

Methods: In this cross-sectional study conducted at 16 sites across Kuwait, Oman, and the United Arab Emirates, eligible patients (aged ≥ 12 years) with asthma were classified based on investigator-defined disease severity guided by the 2017 Global Initiative for Asthma report and by practice type, i.e., respiratory specialist or primary care physician. Data on demographics, disease characteristics, and prescribed asthma treatments, including SABA, in the 12 months prior to a single, prospective, study visit were transcribed onto electronic case report forms (eCRFs). All analyses were descriptive in nature. Continuous variables were summarized by the number of non-missing values, given as mean (standard deviation [SD]) and median (range). Categorical variables were summarized by frequency counts and percentages.

Results: This study analyzed data from 301 patients with asthma, 54.5% of whom were treated by respiratory specialists. Most patients were female (61.8%), with a mean age of 43.9 years, and 84.4% were classified with moderate-to-severe disease, with a mean (SD) asthma duration of 14.8 (10.8) years. Asthma was partly controlled or uncontrolled in 51.2% of patients, with 41.9% experiencing ≥ 1 severe exacerbation in the 12 months preceding their study visit. Overall, 58.5% of patients were prescribed ≥ 3 SABA canisters, 19.3% were prescribed ≥ 10 canisters, and 13.3% purchased SABA over-the-counter (OTC) in the 12 months before the study visit. Most patients who purchased OTC SABA (92.5%) also received SABA prescriptions. Inhaled corticosteroid/long-acting β2-agonist combinations and oral corticosteroid bursts were prescribed to 87.7% and 22.6% of patients, respectively.

Conclusions: SABA over-prescription was highly prevalent in the Gulf region, compounded by purchases of nonprescription SABA and suboptimal asthma-related outcomes. Increased awareness among policymakers and healthcare practitioners is needed to ensure implementation of current, evidence-based, treatment recommendations to optimize asthma management in this region.

Trial registration: NCT03857178 (ClinicalTrials.gov).

Keywords: Asthma; Exacerbations; Gulf region; Over-prescription; SABINA; Short-acting β2-agonists.

Conflict of interest statement

AAK and HF are employees of AstraZeneca. MJHIB was an employee of AstraZeneca when this study was conducted and has shares in AstraZeneca. AA, NAB, RP, FS, NI, MA, KK, KH, MS, and MN have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1

Patient disposition and study population by investigator-classified asthma severity in SABINA III Gulf cluster cohort. *Patients with a history of asthma for < 12 months. Note: Prescriber type was not recorded for two patients each in mild asthma and moderate-to-severe asthma group. Patients could have been prescribed multiple treatments in the 12 months prior to the study visit. Abbreviations: FDC, fixed-dose combination; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; MT, maintenance therapy; OCS, oral corticosteroids; SABA, short-acting β2-agonist; SABINA, SABA use IN Asthma

Fig. 2

SABA prescriptions stratified by asthma severity in the SABINA III Gulf cluster cohort. *Patients without SABA prescriptions did not report the type of reliever they were using. Note: Prescriber type was not recorded for two patients each in the mild asthma and moderate-to-severe asthma group. Abbreviations: SABA, short-acting β2-agonist; SABINA, SABA use in Asthma