Claire Visser, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
Ayse Özdemir, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
Maaike Ethgen, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
Henk-Jan Guchelaar, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
Martina Teichert, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
ABSTRACT
Background
Pharmacy dispensing data indicate that excessive short-acting β2-agonists (SABA) use as reliever therapy is prevalent in approximately 40% of adult patients with asthma in the Netherlands. This may reflect poor asthma control. However, dispensing data are a proxy measure, representing the acquisition of SABA and not necessarily SABA use. Understanding the reasons for excessive SABA dispensing gives the possibility to optimize asthma management in these patients.
Objective
This study aims to determine underlying perceptions, attitudes and behavior associated with excessive SABA dispensing in primary care asthma patients.
Method
Fifty community pharmacies connected to the Leiden University were invited. Primary care asthma patients ≥ 18 years with excessive SABA dispensing were selected from pharmacy dispensing data collected by the Foundation of Pharmaceutical Statistics in October 2021. Patients with excessive SABA dispensing were defined as ≥ 2 SABA dispensing in the past 6 months indicative for an average use of ≥ 2 inhalations per week. Patients were stratified according to SABA monotherapy and concomitant inhalation corticosteroids (ICS) controller therapy. Concomitant ICS therapy was established as ≥ 1 ICS dispensing in the past year. Patients were invited to fill out an online questionnaire on their SABA use and were given the opportunity to further clarify their answers in a semi-structured interview. Questionnaires were analyzed with descriptive statistics and interviews were recorded and transcribed for thematic analysis.
Results
A total of 319 eligible patients were invited from 30 pharmacies. The questionnaire was completed in 53 patients (17%) of whom 17 patients participated in a semi-structured interview. Excessive SABA use was reported in 43 patients (81%) with an average of 3.7 (± 2.1) inhalations per day. Misconceptions on adverse effects on asthma progression, a quick onset of SABA and a lack of knowledge on (avoiding) asthma triggers were reported for this behavior in the majority of users. Knowledge on essential inhaler technique steps were missing in 27 users (63%) and annual inhalation instructions were not performed in 33 users (77%). Patients expressed wishes and needs for an annual consult with their healthcare provider and/or supporting apps. Concomitant ICS use was present in 24 users (56%) of which multiple inhaler device types requiring different inhalation techniques were applied for SABA and ICS in 12 users (50%).
Conclusion
Pharmacy dispensing data has the potential to detect excessive SABA use in asthma patients. Identified reasons related to ‘knowledge’, ‘beliefs’ and ‘skills’ for this behavior requires targeted interventions by healthcare providers. Confirmation is warranted in a larger sample size.