People with asthma abuse rescue inhalers


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Experts say that overusing or underusing asthma inhalers can lead to other health problems. MixMedia/Getty Images
  • About 25 million people in the United States have asthma.
  • Researchers say about a quarter misuse their rescue inhalers.
  • They say another quarter are underusing their preventer inhalers.
  • Experts say people with asthma need to be better informed about when to use inhalers.

More than a quarter of people with asthma misuse SABA (or rescue) inhalers.

Another quarter of corticosteroid (or preventer) inhalers are underused, leading to an increased risk of severe asthma attacks.

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

They found that:

  • 26% of people with asthma received over-prescribed SABA inhalers
  • 25% of these people were underusing preventive corticosteroid inhalers

The researchers calculated that helping people who use more than 12 SABA inhalers a year to reduce their use to less than 12 could lead to 70% fewer asthma-related hospitalizations for this group.

“This is an interesting study and seems to shed light on an important issue,” Dr. David Erstein, an allergist and immunologist working with Advanced Dermatology PC in New York, told Healthline. “I think people tend not to think about their breathing until they develop symptoms. Because preventer inhalers don’t offer immediate relief, 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 muscles in the airways and allowing the airways to expand, thereby relieving shortness of breath,” said 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 of asthma treatment and provide symptom relief as well as long-term control and a reduction in the rate of exacerbations.

Previous studies have also addressed this issue.

The Panel survey on medical expenditure 2008-2010, for example, found that nearly 15% of the asthmatic population in the United States used more than one SABA per month. About 60% used long-term controller medication daily, but still required heavy 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, member of the American Association for Respiratory Care, told Healthline.

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

Other changes during an asthma attack include excess mucus in the airways. Also, the 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 disease with variable and recurring symptoms including bronchospasm, inflammation, and hyperactivity,” says Baker. “Poorly controlled asthma can limit daily activities and increase the number of days missed from school or work. It is associated with increased hospitalizations, emergency room visits, and use of oral steroids.

Many people experience an asthma attack or a worsening of symptoms due to 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 full, active lives.

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.
  • Biological drugs are administered by injection or infusion. They target a cell or protein to prevent swelling in the airways. People with certain types of persistent asthma could benefit from biologics.

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

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

Researchers in the recent study believe healthcare professionals should support and educate patients about 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 use of SABA and increase preventative measures, they noted.

“In the United States, reasons for non-compliance with corticosteroid inhalers include cost, inadequate education regarding the inflammatory origins of asthma, and oral side effects, which may include oral discomfort,” said Dr. Jooby Babu, a pulmonologist in Southern California, told Healthline. . “The LABA/ICS combination consists of inhaled corticosteroids and a long-acting beta-agonist. Patients using this combination have significantly fewer asthma episodes and fewer hospitalizations.

“During my clinic visits to patients, I often ask them how often they use their SABA,” he added. “If it’s more than once a week, I put 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 is no one-size-fits-all solution to SABA overuse. Experts say education should be personalized for each person.

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

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