New analysis of respiratory inhaler medicine use in the UK shows that 83% of all short-acting beta-2-agonist (SABA) relievers for asthma are prescribed to patients who are potentially overusing their reliever medication (prescribed ≥3 inhalers/year).1 The overuse of SABA relievers represents 9.24 million SABA prescriptions and is responsible for 250,000 tonnes of CO2 equivalent annually.1
The prescription of three or more SABA asthma inhalers per year is associated with poor asthma control and approximately twice the number of attacks
These findings will be presented at the British Thoracic Society Winter Meeting and are based on SABA prescription and use data extracted from the UK study in the SABA Use IN Asthma (SABINA) global programme of harmonised, large-scale observational studies collected between 2007-2017.2
The prescription of three or more SABA inhalers per year is associated with poor asthma control, approximately twice the number of exacerbations compared with low SABA users (prescribed 0-2 inhalers/year) and increased asthma-related healthcare utilisation.2,3 Asthma is a chronic, variable, inflammatory disease affecting 5.4 million people in the UK (4.3 million adults) and can cause asthma attacks and symptoms including breathlessness and wheezing.4,5 Every 10 seconds someone in the UK has a potentially life-threatening asthma attack with, on average, three people dying from asthma every day.5
Alexander J K Wilkinson, Consultant in Respiratory and General Medicine, East and North Hertfordshire NHS Trust, Stevenage, UK and lead author of the study said: “Overuse of reliever inhalers in asthma is widespread in the UK and associated with an increased risk of exacerbations for patients, highlighting the importance of adopting strategies to improve disease control and reduce short-acting beta-2-agonist overuse. This new analysis shows that reliever overuse is also a major contributor to greenhouse gas emissions in respiratory care, similar to driving an average diesel car for about 900 million miles. These findings are important for informing clinical guidelines and healthcare policies to support improvements in asthma care while also realising carbon savings.”
Alex de Giorgio-Miller, Vice President, Medical & Scientific Affairs, AstraZeneca UK, said: “We know that the overuse of SABA ‘reliever’ inhalers is associated with an increased risk of severe asthma attacks, but this analysis highlights the scale of the problem we face in the UK, both in terms of poor health outcomes and the corresponding greenhouse gas burden. By reducing over-reliance on SABA inhalers and improving asthma outcomes, we can also have an important positive impact on the environment.”
Further results from the analysis showed that SABA inhaler use drives 70% of greenhouse gas emissions (GHG) from inhaler devices in the UK.1 The per capita use of all SABA reliever inhalers in the UK was approximately treble or more than that observed in other large European countries, resulting in even higher GHG emissions.1
- Wilkinson AJK, Menzies-Gow A, Sawyer M, et al. An assessment of short-acting β2-agonist (SABA) use and subsequent greenhouse gas (GHG) emissions in five European countries and the consequence of their potential overuse for asthma in the U.K. BTS Oral Abstract No: S26. http://dx.doi.org/10.1136/thorax-2020-BTSabstracts.32 [Last accessed: 16 Feb 2021]
- Bloom CI, Cabrera C, Arnetorp S, et al. Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program. Adv Ther 2020; 37: 4190–4208.
- Nwaru BI, Ekström M, Hasvold P, et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020; 55 (4): 1901872.
- Global Initiative for Asthma. 2020 GINA Report, Global Strategy for Asthma Management and Prevention. [Online]. Available at: https://ginasthma.org/gina-reports/. [Last accessed: 1 Feb 2021]
- Asthma facts and statistics. [Online] Available at: https://www.asthma.org.uk/about/media/facts-and-statistics/. [Last accessed: 16 Feb 2021]
- The Global Asthma Network. The Global Asthma Report 2018. [Online]. Available at: http://www.globalasthmanetwork.org/. [Last accessed: 16 Feb 2021].
- National Heart, Lung, and Blood Institute. Guidelines for the Diagnosis and Management of Asthma (EPR-3). [Online]. Available at: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma. [Last accessed: 16 Feb 2021].
- Olaguibel JM, Quirce S, Julia B, et al. Measurement of asthma control according to Global Initiative for Asthma guidelines: a comparison with the Asthma Control Questionnaire. Respir Res. 201; 13: 50.
- Price D, Fletcher M, van der Molen T. Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24: 14009.
- Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008; 31: 143–78.
- AstraZeneca Pharmaceuticals. Data on file. Budesonide/formoterol: Annual Rate of Exacerbations Globally (ID:SD-3010-ALL-0017).
- Sastre J, Fabbri LM, Price D, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016; 9: 13.
- Humbert M, Andersson TL, Buhl R. Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma. Allergy. 2008; 63: 1567–80.
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- Tattersfield AE, Postma DS, Barnes PJ, et al. on behalf of the FACET International Study Group. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. Am J Respir Crit Care Med. 1999; 160: 594–9.
- Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol. 2002; 110: 58–64.
- Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018; 11: 193–204.
- Panigone S, Sandri F, Ferri R, et al. Environmental impact of inhalers for respiratory diseases: decreasing the carbon footprint while preserving patient-tailored treatment. BMJ Open Respir Res. 2020; 7 (1): e000571.
- UK Government GHG Conversion Factors for Company Reporting version 1.3. Department for Business, Energy & Industrial Strategy and Department for the Environment, Food & Rural Affairs. https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2019 [Last accessed: 16 Feb 2021].
- Cabrera CS, Nan C, Lindarck N, et al. SABINA: global programme to evaluate prescriptions and clinical outcomes related to short-acting β2-agonist use in asthma. Eur Respir J. 2020; 55 (2):1901858.