446
Views
0
CrossRef citations to date
0
Altmetric
Commentary

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

, MMed, MB BCh BAO, , MMed, MBChB, BSc(Med), , PhD, BPharm, , MMed, MBBS, , MMed, MBBS, , MMed, MRCP, MD, , MPharm Clin, BPharm, , MMed, MBBS, , FRCP, MBBS, , FRCP, MBBS, , MMed, MBBS, , MMed, MBBS & , MMed, MB BCh BAO show all
Received 12 Jan 2024, Accepted 26 May 2024, Published online: 01 Jul 2024

References

  • Nwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β(2)-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. doi:10.1183/13993003.01872-2019.
  • Wang CY, Lai CC, Wang YH, Wang HC. The prevalence and outcome of short-acting β2-agonists overuse in asthma patients in Taiwan. NPJ Prim Care Respir Med. 2021;31(1):19. doi:10.1038/s41533-021-00231-1.
  • FitzGerald JM, Tavakoli H, Lynd LD, Al Efraij K, Sadatsafavi M. The impact of inappropriate use of short acting beta agonists in asthma. Respir Med. 2017;131:135–140. doi:10.1016/j.rmed.2017.08.014.
  • Global Initiative for Asthma - GINA. Global strategy for asthma management and prevention (2019 update) [assessed 15 May 2024]. https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf.
  • Ban AY-L, Vengadasalam P, Taher SW, Mohd Zim MA, Sirol Aflah SS, Daut UN, Hyder Ali IA, Pereirasamy L, Omar A, Ibrahim A, et al. Short-acting β(2)-agonist prescription patterns and clinical outcomes in Malaysia: a nationwide cohort of the SABINA III study. Malays Fam Physician. 2023;18:32. doi:10.51866/oa.258.
  • Wang HC, Djajalaksana S, Sharma L, Theerakittikul T, Lim HF, Yoo KH, et al. Evaluation of short-acting Beta-2-agonist prescriptions and associated clinical outcomes: findings from the SABA use IN Asthma (SABINA) study in Asia. World Allergy Organ J. 2023;16(10):100823.
  • Slejko JF, Ghushchyan VH, Sucher B, Globe DR, Lin S-L, Globe G, Sullivan PW. Asthma control in the United States, 2008–2010: indicators of poor asthma control. J Allergy Clin Immunol. 2014;133(6):1579–1587. doi:10.1016/j.jaci.2013.10.028.
  • den Akker IL, Werkhoven A, Verheij T. Over-prescription of short-acting beta agonists in the treatment of asthma. Fam Pract. 2021;38(5):612–616. doi:10.1093/fampra/cmab013.
  • Azzi EA, Kritikos V, Peters MJ, Price DB, Srour P, Cvetkovski B, Bosnic-Anticevich S. Understanding reliever overuse in patients purchasing over-the-counter short-acting beta(2) agonists: an Australian community pharmacy-based survey. BMJ Open. 2019;9(8):e028995. doi:10.1136/bmjopen-2019-028995.
  • Department of Statistics Malaysia. Malaysia at a glance [assessed 3 April 2024. https://open.dosm.gov.my/.
  • Ministry of Health Malaysia. National Health and Morbidity Survey 2011. Volume III: healthcare demand and out-of-pocket health expenditure [assessed 15 May 2024] https://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2011-VolumeIII.pdf.
  • Thomas S, Beh L, Nordin RB. Health care delivery in Malaysia: changes, challenges and champions. J Public Health Afr. 2011;2(2):e23. doi:10.4081/jphia.2011.e23.
  • Ministry of Health Malaysia. National Health and Morbidity Survey 2019. Non-communicable diseases, healthcare demand, and health literacy: key findings. [assessed 15 May 2024] https://iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Infographic_Booklet_NHMS_2019-English.pdf.
  • Bateman ED, Price DB, Wang H-C, Khattab A, Schonffeldt P, Catanzariti A, van der Valk RJP, Beekman MJHI. Short-acting β(2)-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J. 2022;59(5):2101402. doi:10.1183/13993003.01402-2021.
  • Chin MC, Sivasampu S, Khoo EM. Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: a national study in Malaysia. PLOS One. 2017;12(6):e0180443. doi:10.1371/journal.pone.0180443.
  • Poh ME, Ampikaipakan S, Liam CK, Chai CS, Ramanaidoo D, Haja Mydin H. Management of asthma exacerbations in Southeast Asian tertiary care. J Asthma Allergy. 2021;14:629–640. doi:10.2147/JAA.S309143.
  • Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Public Health. 1984;74(9):979–983. doi:10.2105/ajph.74.9.979.
  • Broder MS, Gibbs SN, Yermilov I. An adaptation of the RAND/UCLA modified Delphi panel method in the time of COVID-19. J Healthc Leadersh. 2022;14:63–70.
  • Global Initiative for Asthma - GINA. Global strategy for asthma management and prevention 2024. update) [assessed 15 May 2024]. https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Main-Report-WMS-1.pdf.
  • Ministry of Health Malaysia. Malaysian CPG for Management of Asthma in Adult 2017 assessed 26 September 2024. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/CPG%20Management%20of%20Asthma%20in%20Adults.pdf.
  • Asthma Respiratory Foundation NZ. New Zealand adolescent & adult asthma guidelines 2020. [assessed 26 September 2023]. https://www.nzrespiratoryguidelines.co.nz/uploads/8/3/0/1/83014052/arfnz_adolescent_and_adult_asthma_guidelines_.pdf.
  • National Asthma Council Australia. Australian asthma handbook assessed 26 September 2023. https://www.asthmahandbook.org.au/acute-asthma/clinical/post-acute-care.
  • International Primary Care Respiratory Group. Asthma right care case study [assessed 27 September 2023. https://www.ipcrg.org/sites/ipcrg/files/content/attachments/2021-09-13/SABA%20OTC%20Case%20Study%20-%20FINAL.pdf.
  • The Swedish National Airway Register assessed 28 September 2023. https://lvr.registercentrum.se/in-english/the-swedish-national-airway-register/p/HJAjrgGPD.
  • NIHR Global Health Research Unit on Respiratory Health (RESPIRE) UoE. What is RESPIRE? assessed 28 September 2023. https://www.ed.ac.uk/usher/respire/about/what-is-respire.
  • Ministry of Health Malaysia. National Health & Morbidity Survey 2023. [accessed 28 September 2023]. Available from: https://iku.gov.my/nhms-2023.
  • Ministry of Health Malaysia. Respiratory medication therapy adherence clinic protocol—asthma/COPD (adult & pediatric), 2nd edition [accessed 2 October 2023. https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/book.-protocol-respiratory-2.6-ver2_0.pdf.
  • British Thoracic Society. BTS/SIGN Guideline for the management of asthma 2019 [accessed 3 October 2023]. https://www.brit-thoracic.org.uk/document-library/guidelines/asthma/bts-sign-guideline-for-the-management-of-asthma-2019/.
  • International Primary Care Respiratory Group. Reliever Reliance Test - English [accessed 2 November 2023. https://www.ipcrg.org/resources/search-resources/reliever-reliance-test-english.
  • Mohd Isa NA, Cheng CL, Nasir NH, Naidu V, Gopal VR, Alexander AK. Asthma control and asthma treatment adherence in primary care: results from the prospective, multicentre, non-interventional, observational cohort ASCOPE study in Malaysia. Med J Malaysia. 2020;75(4):331–337.
  • Hussein N, Ramli R, Ishak I, Ho BK, Mohamad Isa S, Aman Z, Nordin A, Tan SF, Harun H, Liew SM, et al. Assessment of asthma control and associated risk factors: findings from the Klang Asthma Cohort Study in Malaysia. Eur Respir J. 2021;58(suppl 65):PA1001. doi:10.1183/13993003.congress-2021.PA1001.
  • Loh ZC, Hussain R, Balan S, Saini B, Muneswarao J, Ong SC, Babar Z-U-D. Perceptions, attitudes, and behaviors of asthma patients towards the use of short-acting β2-agonists: a systematic review. PLOS One. 2023;18(4):e0283876. doi:10.1371/journal.pone.0283876.
  • Blakeston S, Harper G, Zabala Mancebo J. Identifying the drivers of patients’ reliance on short-acting β2-agonists in asthma. J Asthma. 2021;58(8):1094–1101. doi:10.1080/02770903.2020.1761382.
  • Chan AHY, Katzer CB, Horne R, Haughney J, Correia de Sousa J, Williams S, et al. SABA Reliance Questionnaire (SRQ): identifying patient beliefs underpinning reliever overreliance in asthma. J Allergy Clin Immunol Pract. 2020;8(10):3482–3489.
  • Ellis AK, Foran V, Kaplan A, Mitchell PD. Clarifying SABA overuse: translating Canadian Thoracic Society guidelines into clinical practice. Allergy Asthma Clin Immunol. 2022;18(1):48. doi:10.1186/s13223-022-00690-2.
  • Crowther L, Pearson M, Cummings H, Crooks MG. Towards codesign in respiratory care: development of an implementation-ready intervention to improve guideline-adherent adult asthma care across primary and secondary care settings (The SENTINEL Project). BMJ Open Respir Res. 2022;9(1):e001155. doi:10.1136/bmjresp-2021-001155.
  • Crooks MG, Crowther L, Cummings H, Cohen J, Huang C, Pitel L, Pearson M, Morice A, Turgoose J, Faruqi S, et al. Improving asthma care through implementation of the SENTINEL programme: findings from the pilot site. ERJ Open Res. 2023;9(3):00685–2022. doi:10.1183/23120541.00685-2022.
  • Albertson TE, Sutter ME, Chan AL. The acute management of asthma. Clin Rev Allergy Immunol. 2015;48(1):114–125. doi:10.1007/s12016-014-8448-5.
  • Emirates Thoracic Society. Algorithm for the management of adult asthma in the emergency department. 2021.
  • IQVIA IMS. SABA inhalers and tablets dispensed in Malaysia. 2019.
  • Gibson P, Henry D, Francis L, Cruickshank D, Dupen F, Higginbotham N, Henry R, Sutherland D. Association between availability of non-prescription b2 agonist inhalers and undertreatment of asthma. BMJ. 1993;306(6891):1514–1518. doi:10.1136/bmj.306.6891.1514.
  • Loh ZC, Hussain R, Ong SC, Saini B, Muneswarao J, Ur-Rehman A, et al. Over-the-counter use of short-acting beta-2 agonists: a systematic review. J Pharm Policy Pract. 2023;16(1):119.
  • Kaplan AG, Correia-de-Sousa J, McIvor A, Global Policy Steering Group on Improving Asthma Outcomes Global quality statements on reliever use in asthma in adults and children older than 5 years of age. Adv Ther. 2021;38(3):1382–1396. doi:10.1007/s12325-021-01621-0.
  • Drug Topics. OTC update: asthma medications [accessed 27 September 2023. https://www.drugtopics.com/view/otc-update-asthma-medications.
  • Lee H, Ryu J, Chung SJ, Yeo Y, Park TS, Park DW, Moon J-Y, Kim T-H, Sohn JW, Yoon HJ, et al. Short-acting beta2-agonist use in asthma in Korea: a 10-Year population-based study. Allergy Asthma Immunol Res. 2021;13(6):945–953. doi:10.4168/aair.2021.13.6.945.
  • Crossingham I, Turner S, Ramakrishnan S, Fries A, Gowell M, Yasmin F, et al. Combination fixed-dose beta agonist and steroid inhaler as required for adults or children with mild asthma. Cochrane Database Syst Rev. 2021;5(5):Cd013518.
  • Sobieraj DM, Weeda ER, Nguyen E, Coleman CI, White CM, Lazarus SC, Blake KV, Lang JE, Baker WL. Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. JAMA. 2018;319(14):1485–1496. doi:10.1001/jama.2018.2769.
  • Beasley R, Harrison T, Peterson S, Gustafson P, Hamblin A, Bengtsson T, Fagerås M. Evaluation of budesonide-formoterol for maintenance and reliever therapy among patients with poorly controlled asthma: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(3):e220615. doi:10.1001/jamanetworkopen.2022.0615.
  • Patel M, Pilcher J, Hancox RJ, Sheahan D, Pritchard A, Braithwaite I, et al. The use of β2-agonist therapy before hospital attendance for severe asthma exacerbations: a post-hoc analysis. NPJ Prim Care Respir Med. 2015;25:14099.
  • Tattersfield AE, Postma DS, Barnes PJ, Svensson K, Bauer CA, O’Byrne PM, Löfdahl CG, Pauwels RA, Ullman A. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group. Am J Respir Crit Care Med. 1999;160(2):594–599. doi:10.1164/ajrccm.160.2.9811100.
  • Dhruve H, d’Ancona G, Nanzer-Kelly A, Jackson DJ. Adherence to inhaled corticosteroids (ICS) according to demographic characteristics in asthma (Abstract P115). Thorax. 2021;76: a 1–A256.
  • Wang J, Zhai C, Wang Q, Shi W, Fang W, Yan X, Zhang Q, Xie X, Li S, Li M, et al. Determinants of ICS therapy adherence in patients with asthma. Am J Manag Care. 2021;27(2):e36–e41. doi:10.37765/ajmc.2021.88587.
  • Teng SY, Yusoff AM, Foong SY, Aziz H, Mohamad Pakarul Razy NH, Hashim NI, et al. A cross sectional study on adult asthma patients’ adherence to inhaled corticosteroids (ICS) in Hospital Putrajaya (P55). Med J Malaysia. 2021;76:33.
  • Nannini LJ, Neumayer NS, Brandan N, Fernández OM, Flores DM. Asthma-related hospitalizations after implementing SABA-free asthma management with a maintenance and anti-inflammatory reliever regimen. Eur Clin Respir J. 2022;9(1):2110706. doi:10.1080/20018525.2022.2110706.
  • Kponee-Shovein K, Marvel J, Ishikawa R, Choubey A, Kaur H, Thokala P, et al. Carbon footprint and associated costs of asthma exacerbation care among UK adults. J Med Econ. 2022;25(1):524–531.
  • Levy ML, Bateman ED, Allan K, Bacharier LB, Bonini M, Boulet LP, et al. Global access and patient safety in the transition to environmentally friendly respiratory inhalers: the Global Initiative for Asthma perspective. Lancet. 2023;402(10406):1012–1016.
  • Kocks JWH, Chrystyn H, van der Palen J, Thomas M, Yates L, Landis SH, et al. Systematic review of association between critical errors in inhalation and health outcomes in asthma and COPD. NPJ Prim Care Respir Med. 2018;28(1):43.
  • Price DB, Román-Rodríguez M, McQueen RB, Bosnic-Anticevich S, Carter V, Gruffydd-Jones K, et al. Inhaler errors in the CRITIKAL Study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5(4):1071–1081.
  • Roche N, Aggarwal B, Boucot I, Mittal L, Martin A, Chrystyn H. The impact of inhaler technique on clinical outcomes in adolescents and adults with asthma: a systematic review. Respir Med. 2022;202:106949. doi:10.1016/j.rmed.2022.106949.
  • Klijn SL, Hiligsmann M, Evers S, Román-Rodríguez M, van der Molen T, van Boven JFM. Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review. NPJ Prim Care Respir Med. 2017;27(1):24. doi:10.1038/s41533-017-0022-1.
  • Jia X, Zhou S, Luo D, Zhao X, Zhou Y, Cui YM. Effect of pharmacist-led interventions on medication adherence and inhalation technique in adult patients with asthma or COPD: a systematic review and meta-analysis. J Clin Pharm Ther. 2020;45(5):904–917. doi:10.1111/jcpt.13126.
  • Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J. 2015;45(2):396–407. doi:10.1183/09031936.00075614.
  • Plaza V, Fernández-Rodríguez C, Melero C, Cosío BG, Entrenas LM, de Llano LP, et al. Validation of the ‘test of the adherence to inhalers’ (TAI) for asthma and COPD Patients. J Aerosol Med Pulm Drug Deliv. 2016;29(2):142–152.
  • Muneswarao J, Hassali MA, Ibrahim B, Saini B, Naqvi AA, Hyder Ali IA, et al. Translation and validation of the test of adherence to inhalers (TAI) questionnaire among adult patients with asthma in Malaysia. J Asthma. 2021;58(9):1229–1236.
  • Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, Bower P, Sheikh A, Griffiths CJ, Taylor SJC, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med. 2017;15(1):64. doi:10.1186/s12916-017-0823-7.
  • Hodkinson A, Bower P, Grigoroglou C, Zghebi SS, Pinnock H, Kontopantelis E, Panagioti M. Self-management interventions to reduce healthcare use and improve quality of life among patients with asthma: systematic review and network meta-analysis. BMJ. 2020;370:m2521. doi:10.1136/bmj.m2521.
  • Vogelmeier C, Naya I, Ekelund J. Budesonide/formoterol maintenance and reliever therapy in Asian patients (aged ≥16 years) with asthma: a sub-analysis of the COSMOS study. Clin Drug Investig. 2012;32(7):439–449. doi:10.2165/11598840-000000000-00000.
  • Beasley R, Holliday M, Reddel HK, Braithwaite I, Ebmeier S, Hancox RJ, Harrison T, Houghton C, Oldfield K, Papi A, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380(21):2020–2030. doi:10.1056/NEJMoa1901963.
  • O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, Jorup C, Lamarca R, Ivanov S, Reddel HK, et al. Inhaled combined budesonide-formoterol as needed in mild asthma. N Engl J Med. 2018;378(20):1865–1876. doi:10.1056/NEJMoa1715274.
  • Bateman ED, Reddel HK, O’Byrne PM, Barnes PJ, Zhong N, Keen C, Jorup C, Lamarca R, Siwek-Posluszna A, FitzGerald JM, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378(20):1877–1887. doi:10.1056/NEJMoa1715275.
  • Hussein N, Liew SM, Hanafi NS, Lee PY, Cheong AT, Ghazali SS, et al. Asthma control and care among six public health clinic attenders in Malaysia: a cross-sectional study. Health Sci Rep. 2023;6(5):e1021.
  • Bridgeman MB, Wilken LA. Essential role of pharmacists in asthma care and management. J Pharm Pract. 2021;34(1):149–162. doi:10.1177/0897190020927274.
  • Yong YV, Shafie AA. Using a dynamic adherence Markov model to assess the efficiency of respiratory medication therapy adherence clinic (RMTAC) on asthma patients in Malaysia. Cost Eff Resour Alloc. 2018;16(1):36. doi:10.1186/s12962-018-0156-1.
  • Chiew SY, Ghazali NH, Choon CJ, Chang PN, Lee MY, Yap LS, et al. Cost-effectiveness of pharmacist-managed respiratory medication therapy adherence clinic (RMTAC) on asthma patients: a prospective multicentre study. Pharm Res Rep. 2022;5(2):18–27.
  • García-Cárdenas V, Sabater-Hernández D, Kenny P, Martínez-Martínez F, Faus MJ, Benrimoj SI. Effect of a pharmacist intervention on asthma control. A cluster randomised trial. Respir Med. 2013;107(9):1346–1355. doi:10.1016/j.rmed.2013.05.014.
  • Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, Annemans L, Remon JP, et al. Effectiveness of pharmacist intervention for asthma control improvement. Eur Respir J. 2008;31(4):790–799.
  • Wong MD, Manley RT, Stettin G, Chen W, Salmun LM. Intervention to reduce unnecessary dispensing of short-acting beta-agonists in patients with asthma. Ann Pharmacother. 2010;44(4):623–629. doi:10.1345/aph.1M697.
  • Meghji J, Mortimer K, Agusti A, Allwood BW, Asher I, Bateman ED, et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet. 2021;397(10277):928–940.
  • Williams S, Sheikh A, Campbell H, Fitch N, Griffiths C, Heyderman RS, et al. Respiratory research funding is inadequate, inequitable, and a missed opportunity. Lancet Respir Med. 2020;8(8):e67–e68.
  • Levy ML. The national review of asthma deaths: what did we learn and what needs to change? Breathe . 2015;11(1):14–24. doi:10.1183/20734735.008914.
  • Hussein N, Ramli R, Liew SM, Hanafi NS, Lee PY, Cheong AT, Sazlina S-G, Mohd Ahad A, Patel J, Schwarze J, et al. Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia. NPJ Prim Care Respir Med. 2023;33(1):13. doi:10.1038/s41533-023-00337-8.