National expert consensus on short-acting beta₂-agonist overreliance in asthma care in Malaysia

Figures & data

Figure 1. Flow diagram on the development process of the expert consensus on SABA overreliance in Malaysia.

Table 1. Consensus statements on SABA overreliance in Malaysia, and the distribution of second-round agreement ratings.

Statements	Second-round voting agreement (%)^a
Burden of SABA overreliance in Malaysia
Statement 1: SABA overreliance is highly prevalent in Malaysian asthma care across various healthcare settings, including, but not limited to, primary and specialty care, emergency department, as well as community pharmacy.	100%
Statement 2: SABA overreliance will lead to poor asthma control and increased risks of asthma exacerbations, hospitalization and mortality.	100%
Statement 3: SABA overreliance is a major healthcare issue in asthma care, which warrants proactive, urgent and systematic intervention in the national health systems.	100%
Recommendations to eliminate SABA overprescription and overreliance
Statement 4: Patients with asthma on SABA treatment should receive an assessment of risk of SABA overreliance.	100%
Statement 5: The number of SABA canisters utilized by patients with asthma should be controlled and monitored, whereby it should not exceed 2 canisters/year.	85%
Statement 6: Patients with asthma discharged from hospital/clinic/emergency department following an acute exacerbation should receive ICS-containing treatment and not SABA monotherapy.	92%
Statement 7: SABA should only be dispensed with prescription.	85%
Statement 8: Where appropriate, GINA Track 1 practice should be implemented in the management of asthma across all severities.	100%
Statement 9: Inhaler technique and medication adherence should be optimized in all patients with asthma while empowering them with self-management education.^b	100%
Statement 10: Increased healthcare resources should be allocated to expand RMTAC pharmacist-led interventions in improving patients’ inhaler technique and treatment adherence, as well as overall mitigation of the risk of SABA overreliance.	100%
Statement 11: Research on asthma-related exacerbation and mortality should be a national healthcare priority.	100%

^a The second-round voting was participated by 13 panel experts.

^b Statement 9 was developed following discussions that took place after the first-round voting, and was rated at the second-round voting.

GINA: Global Initiative for Asthma; ICS: inhaled corticosteroids; RMTAC: Respiratory Medication Therapy Adherence Clinic; SABA: short-acting beta-agonist.

Table

Statements	First-round voting- Agreement (%)^a
Statement 1: SABA overreliance is highly prevalent in Malaysian asthma care across various healthcare settings, including, but not limited to, primary and specialty care, emergency department, as well as community pharmacy.	100%
Statement 2: SABA overreliance will lead to poor asthma control and increased risks of asthma exacerbations, hospitalization and mortality.	100%
Statement 3: SABA overreliance is a major healthcare issue in asthma care, which warrants proactive, urgent and systematic intervention in the national health systems.	100%
Statement 4: Asthma patients on SABA treatment should receive an assessment of risk of SABA overreliance.	100%
Statement 5: The number of SABA canisters utilized by asthma patients should be controlled and monitored, whereby it should not exceed 2 canisters/year.	92%
Statement 6: Asthma patients discharged from hospital/clinic/emergency department following an acute exacerbation should receive ICS-containing treatment and not SABA monotherapy. They should receive proper treatment review and asthma disease education in primary and/or specialty care.	92%
Statement 7: SABA should only be dispensed with prescription.	83%
Statement 8: GINA Track 1 practice should be implemented in the management of asthma across all severities where appropriate.	67%
Statement 9: Increased healthcare resources should be allocated to expand RMTAC pharmacists-led interventions in improving patients’ inhaler technique and treatment adherence, as well as overall mitigation of the risk of SABA overreliance.	83%
Statement 10: Research on asthma-related exacerbation and mortality should be a national healthcare priority.	100%

^a The first-round voting was participated by 12 panel experts.

GINA: global initiative for asthma; ICS: inhaled corticosteroids; RMTAC: respiratory medication therapy adherence clinic; SABA: short-acting beta-agonist.