Identifying the drivers of patients’ reliance on short-acting β2-agonists in asthma

Abstract

Background

One of the most commonly observed asthma treatment patterns is the underuse of inhaled corticosteroid (ICS) maintenance therapy when patients are not experiencing symptoms, and the predominant use of short-acting β2-agonists (SABAs) when patients are experiencing symptoms. This multinational study investigated the current beliefs and behaviors related to reliance on reliever inhalers among asthma patients, and the reasons why patients may not adhere to their recommended maintenance controller treatment.

Methods

This was a qualitative research study, in which 80 patients with asthma who were receiving reliever therapy (i.e. SABAs) were interviewed, in-depth, for 60 min. The interview questions focused on the patients’ experience of living with asthma and their inhaled treatment regimens.

Results

The key insights identified in the interviews were (a) patients had a strong emotional attachment to SABA relievers driven by their efficacy and success in quickly alleviating asthma symptoms, with the reliever also becoming an emotional support; (b) patients typically did not understand that the frequent use of SABAs indicates poor asthma control; (c) patients had a misperception of ICS, which could lead to a delay in escalation and poor adherence; and (d) severe exacerbations improve adherence to ICS, but only temporarily in many cases.

Conclusion

This study confirmed the poor level of control patients have over their asthma, and how this affects their lifestyle and daily activities. Our results also confirmed that the patients’ perception of both the disease and treatment plays a key role in SABA reliance and ICS underuse.

Keywords:

• Asthma
• SABA
• ICS
• adherence
• reliance
• behavior

Availability of data and materials

Source data and material will be made available upon reasonable request.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Ethics approval and consent to participate

Due to the marketing research nature of the study, ethics approval was not required in any of the countries where the interviews were conducted, and therefore, it was not sought. The study methodology adhered to the Legal and Ethical Guidelines for Healthcare Market Research published by the British Healthcare Business Intelligence Association (BHBIA), ensuring full data anonymity of participants. All respondents provided informed consent to participate in the study, and were made aware of the study objectives on recruitment. All data were anonymised and aggregated for the final analysis.

Authors’ contributions

Acquisition of data: SB and GH.

Analysis and interpretation of data: SB, GH and JZM.

Drafting of manuscript: JZM.

All authors read and approved the final manuscript.

Additional information

Funding

This study was supported by AstraZeneca, Cambridge, UK.