Study confirms overuse of asthma pumps

Asthma is an inflammatory condition of the airways affecting more than 339 million people globally.

In South Africa, more than 20% of children and 10-15% of adults have asthma.

For those living with the illness, it can reduce quality of life in varying degrees and it’s not uncommon to be hospitalised during an attack.

Despite changes in the approach to treatment and evidenced-based medications to manage the condition, an alarming number of South Africans still die from asthma every year.

With the fifth highest asthma death rate in the world, the importance of local research such as the recently published SABINA III study cannot be overstated.

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The new study primarily set out to review asthma SABA prescription patterns among South African patients.

The findings were conclusive, showing over-prescription and over-the-counter purchase of the reliever pump to be widespread, despite the new guidelines in place for treating the illness.

According to Professor Ismail Kalla, pulmonologist and head of the department of internal medicine at the University of Witwatersrand, the significant overuse of the blue SABA reliever pump is a serious problem for South African asthma patients.

Kalla added that for decades asthmatic patients have been overusing their blue SABA symptom-reliever inhaler (which provides rapid and temporary relief) and underusing their anti-inflammatory maintenance medication.

“In line with the new global, and locally endorsed asthma treatment guidelines, we no longer prescribe SABA blue reliever inhalers alone as the preferred reliever therapy for mild asthma.

“Instead, we recommend the use of a low-dose inhaled corticosteroid (ICS) formoterol therapy as needed, regardless of asthma disease severity.

“This combination inhaler contains an anti-inflammatory agent, which reduces inflammation of the airways and provides controlled relief.”

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Despite the new way of treating asthma, the SABINA III results indicate a slow uptake of the new guidelines.

Nearly 75% of the study patients used more than three SABA canisters in the previous 12 months and over 55% were prescribed more than 10 SABA canisters.

“These figures are extremely concerning, as there is increasing evidence that SABA overuse, and in particular the use of more than three pumps a year, is associated with an increased risk of asthma attacks, hospitalisations and death,” explained Prof Kalla.

“Patients who are using this many blue pumps in a year should speak to their doctor immediately to re-examine and revise their asthma treatment plan.”

Kalla explained that chronic control relies on anti-inflammatory maintenance and this applies to all asthma patients – whether their illness has been classified as mild, moderate or severe.

He added that the approach to treatment and management of asthma is almost identical and reducing inflammation is at the heart of it.

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“What’s more, patients with mild asthma must recognise that their disease severity doesn’t preclude them from having an asthma attack. The risk is equally as high regardless of disease severity, adherence to treatment, or level of control,” warns Prof Kalla.

Congruently, the SABINA III study found that more than 50% of mild asthmatic patients have uncontrolled symptoms.

Not taking maintenance medication as prescribed is believed to be the reason for continued poor control.

Of these 501 patients analysed, 60% were uncontrolled or only partly controlled. Nearly 50% had experienced more than one severe asthma attack in the 12 months before the study.

When it comes to childhood asthma the same treatment recommendations apply.

Moreover, in children, mild asthma is more frequent, symptomatic, and less controlled than in adults. But, as with adults, everything boils down to reducing inflammation and the overuse of their SABA inhaler also increases their risk of an attack.

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If inflammation and swelling are not treated, over time the airway walls may thicken permanently, preventing them from working efficiently.

He said while there’s no cure for asthma it can be controlled and asthmatics must partner with their doctor to develop a solid asthma treatment plan that prioritises reducing inflammation safely.

To educate people living with asthma, and to help them reduce their risk of attacks, AstraZeneca is running the break over-reliance campaign.

Asthma patients can assess their levels of over-reliance through a digital assessment tool, known as the reliever reliance test.