People With Asthma Tend to Overuse or Underutilize Inhalers: What Can Be Done

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Experts say overusing or underutilizing asthma inhalers can lead to other health issues. MixMedia/Getty Images
  • About 25 million people in the United States have asthma.
  • Researchers say about one-fourth of them overuse their rescue inhalers.
  • They say another one-fourth underuse their preventive inhalers.
  • Experts say people with asthma need to be better informed about when to use inhalers.

More than one-fourth of people with asthma overuse SABA (or rescue) inhalers.

Another one-fourth of underuse corticosteroid (or preventive) inhalers, leading to an increased risk of severe asthma attacks.

That’s according to a new study by researchers at the Clinical Effectiveness Group at Queen Mary University in London who analyzed more than 700,000 patient records from 117 general medical practices.

They found that:

  • 26 percent of people with asthma were overprescribed SABA inhalers
  • 25 percent of those people were underusing preventive corticosteroid inhalers

The researchers calculated that helping people who use more than 12 SABA inhalers per year reduce their use to less than 12 could result in 70 percent fewer asthma-related hospital admissions for that group.

“This is an interesting study and seems to bring to light an important issue,” Dr. David Erstein, an allergist and immunologist working with Advanced Dermatology PC in New York, told Healthline. “I think people tend to not think about their breathing until they develop symptoms. Because the preventative inhalers don’t offer immediate help, they turn to their rescue inhaler.”

SABAs are short-acting beta-agonists for use as needed, such as during an acute asthma attack.

“They work by relaxing the airway muscles and allowing the airway to dilate, relieving shortness of breath,” Dr. Fady Youssef, a pulmonologist, internist, and critical care specialist at MemorialCare Long Beach Medical Center in California. “They don’t provide long-term disease control, just immediate symptomatic relief. Inhaled corticosteroids are a cornerstone in treating asthma and provide symptom relief as well as long-term control and reduction in the rate of exacerbations.”

Past studies have also looked at this issue.

The 2008-2010 Medical Expenditure Panel Survey, for example, found that nearly 15 percent of the asthma population in the United States used more than one SABA per month. About 60 percent used daily long-term control medications but still required significant use of quick-relief inhalers.

“When asthma is well controlled, the frequency of SABAs should be two or fewer days per week,” Joyce Baker, MBS, RRT, a fellow of the American Association for Respiratory Care, told Healthline.

What is asthma?

Asthma affects the lungs when the airways can become inflamed, narrowing the airflow pathway in and out of the lungs.

Other changes during an asthma attack include excess mucus in the airways. In addition, muscles surrounding the airways can tighten, reducing the ability to breathe.

About 25 million people in the United States have asthma. It often starts in childhood.

“Asthma is a common, chronic condition with variable and recurrent symptoms, including bronchospasms, inflammation, and hyperactivity,” says Baker. “Poorly controlled asthma can limit daily activities and increase the number of missed school or workdays. It is associated with increased hospitalizations, emergency department visits, and oral steroid use.”

Many people experience an asthma attack or worsening symptoms because of a trigger. Common triggers include:

  • Pollen
  • Exercise
  • Viral infections
  • Cold air

There is currently no cure for asthma. However, with proper medical care, it is manageable.

Experts say people who learn to control their asthma can lead a full and active life.

How is asthma treated?

There are several treatments available for asthma:

  • Quick-relief inhalers, sometimes called rescue inhalers, are used when you experience sudden symptoms. They are most effective when used at the first sign of symptoms.
  • Controller inhalers are used daily to prevent asthma symptoms by reducing swelling and excess mucus in the airways.
  • Biologic medicines are given via injection or infusion. They target a cell or protein to prevent swelling in the airways. People with certain types of persistent asthma might benefit from biologics.

A fourth option, which combines the quick-relief and controller inhalers, helps with short-term relief and long-term control.

The Asthma and Allergy Foundation of America includes these in its treatment guidelines. However, the Food and Drug Administration has not yet approved them for this purpose.

What can be done?

The researchers in the recent study believe medical professionals should support and educate patients on the proper use and dangers of overuse of SABA inhalers.

Primary physicians, specialists such as allergists, and pharmacists have tools to help people reduce their SABA use and increase preventive measures, they noted.

“In the United States, reasons for noncompliance with corticosteroid inhalers include the cost, inadequate education regarding the inflammatory origins of asthma, and oral side effects, which can include oral discomfort,” Dr. Jooby Babu, a pulmonologist in Southern California, told Healthline. “The LABA/ICS combination is inhaled corticosteroids and a long-acting beta-agonist. Patients who use this combination have noticeably decreased episodes of asthma and decreased hospitalizations.”

“During my patient clinic visits, I often ask about how often they use their SABA,” he added. “If it is more than once a week, I place them on inhaled corticosteroids in addition to their SABA. If the exacerbations are still not controlled, I prescribe a long-acting beta-agonist with an inhaled corticosteroid.”

There isn’t a one-size-fits-all way to address SABA overuse. Experts say education should be customized for each person.

“People learn and retain information differently, so it is important to start with having them show me how they use their inhalers. Then I can educate on any gaps in technique or understanding,” explained Baker. “There are many different inhalers on the market today, and technique will vary based on the device. In some cases, specific inhaler devices may not be ideal for the individual based on age and cognitive abilities, leading to overuse. It is also essential to use different teaching mechanisms to best meet the learner’s needs, such as demonstration, teach-back, videos, and handouts.”

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