Short-acting β2-agonists over-prescription in patients with asthma: an Indian subset analysis of international SABINA III study

Abstract

Objective

The SABINA (SABA use IN Asthma) program was initiated to describe short-acting β2-agonists (SABA) prescription patterns and assess the impact of its over-prescription on exacerbation risk and asthma control. We evaluated SABA prescription patterns in patients with asthma in the Indian cohort of SABINA III.

Methods

This multi-centre, observational, cross-sectional study included retrospective and real-time electronic data collection. Data were extracted from medical records of patients with asthma (aged >12 years) having >3 consultations with the same healthcare practitioners between March 2019 and January 2020. The data included prescriptions of SABA and other asthma treatments and over-the-counter (OTC) purchases of SABA. SABA prescriptions were categorized by the number of SABA canisters prescribed in the 12 months preceding the study visit.

Results

A total of 510 patients with asthma were included from specialist care (mean age 49.1 years; 57.65 females), with 8.2% classified with mild asthma and 91.8% with moderate-to-severe asthma. SABA as monotherapy and add-on to maintenance therapy was prescribed to 4.5% (n = 23) and 44.9% (n = 229) of patients, respectively. While ICS monotherapy and ICS/LABA were prescribed to 5.1% (n = 26) and 93.3% (n = 476) of patients, respectively. SABA was found to be over-prescribed (≥3 SABA canisters/year) among 23.9% of patients (n = 122). Additionally, 8% of patients (n = 41) purchased SABA OTC without prescription.

Conclusions

Nearly one-fourth of patients with asthma in India were over-prescribed SABA. Educational programmes targeted at national and regional levels should be expanded to raise greater asthma awareness and encourage the adoption of guideline-directed asthma treatment plans among healthcare practitioners.

Keywords:

• short-acting β2-agonists
• inhaled corticosteroids
• SABINA (SABA use IN Asthma)
• exacerbation
• GINA

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Medical writing, editorial, and other assistance

Medical writing and editorial support was provided by Saleha Rehman (Ph.D.) of THB c/o Sekhmet Technologies Pvt Ltd. (Gurugram, Haryana, India), which was funded by AstraZeneca and conducted in accordance with the GPP3 guidelines (http://www.ismpp.org/gpp3)

Author contribution

M.M., K.M., P.J., L.S., M.P.A., G.G., M.M., S.K., S.N., M.M., A.K.B., and M.S. made substantial contributions to data acquisition, critical review of the manuscript for significant intellectual content, approved the final version of manuscript, and agreed for accountability for all aspects of the work related to its accuracy or integrity. W.S. and M.B. contributed to critical review of the manuscript for significant intellectual content, approved the final version of manuscript, and agreed for accountability for all aspects of the work related to its accuracy or integrity. Additionally, W.S. drafted the article and was involved in data interpretation and M.B. made substantial contribution to conception and design of the study.

Declaration of interest

The author, Waseem Siddiqui, declares that he serves as Medical Affairs Manager - Respiratory & Immunology at AstraZeneca Pharma India Pvt. Ltd. The author, Maarten Beekman, declares that at the time of the study, he served as International Medical Director, Respiratory & Immunology, AstraZeneca, The Hague, Netherlands. Other authors declare no conflict of interest.

Funding

AstraZeneca funded the study; was involved in the study design, protocol development, study conduct and statistical analysis; and was given the opportunity to review the manuscript before submission. AstraZeneca also funded medical writing support. AstraZeneca Pharma India Ltd.

Data availability

Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data sharing policy described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/