Overuse of asthma inhalers linked to severe attacks; study

Data from a massive real-world study of asthma patients has suggested that overuse of inhalers is widespread and leading to an elevated risk of severe exacerbations.

The results from the SABINA registry programme in more than a million people with the respiratory disease show that 40% of patients were over-using short-acting beta agonist (SABA) inhalers, which are used on demand to open up the airways.

The analysis also shows that heavy users who went through three or more SABA inhalers in a year were 32% more likely to experience severe attacks than those using one or two per year, and were less likely to have their symptoms under control.

The finding was independent of the use of maintenance therapy with inhaled corticosteroids (ICS), used to dampen down the inflammation seen in the lungs of people with asthma.

The researchers – which have published their work in the Journal of Allergy and Clinical Immunology and European Respiratory Journal – suggest the link between SABA overuse and severe exacerbations stems from a lack of maintenance therapy, with steroids administered orally intermittently in bursts to tackle attacks, often without face-to-face contact with a physician.

"The SABINA findings reveal that high use of SABA relievers is a common issue in many countries and is associated with a greater risk of severe asthma attacks in patients around the world," said lead investigator Jennifer Quint of the National Heart and Lung Institute at Imperial College London.

"These data reinforce the urgent need to adopt treatment paradigms that improve asthma management, including those from the Global Initiative for Asthma, which no longer recommend SABA as the preferred reliever therapy across all asthma severities," she added.

GINA recommends that as-needed SABAs used in conjunction with background ICS maintenance doses are the preferred way to manage asthma, as studies show a clear decrease in severe exacerbations compared with SABA alone.

There are an estimated 176 million asthma exacerbations globally per year, which are physically threatening and emotionally significant for many patients and can be fatal.

The results were hailed by Mene Pangalos, head of biopharma R&D at AstraZeneca, which has a 50-year heritage in developing respiratory medicines.

"There is a clear need for asthma management that addresses the inflammatory nature of the disease and reduces exacerbation risk to improve outcomes for patients," he said.