‘Hard proof’ of asthma reliever over-reliance

asthma reliever puffer on its side

Nearly 40% of people with asthma only use reliever medicines, new research has found

A study led by Woolcock Institute of Medical Research in Sydney found that 39% of almost 2700 people with asthma surveyed used what researchers call the “ambulance at the bottom of the cliff” option to treat their condition.

This was despite one in four requiring urgent medical treatment each year.

“A quarter of patients who opted to use the reliever only, and no preventer medication, were forced to seek last-minute treatment for a dangerous flare-up in their condition,” says Professor Helen Reddel, lead author of the study, which was published in BMJ Open.

“This is hard proof that people who choose to only treat symptoms as they arise, without also treating the underlying condition, run a very real risk of winding up in hospital.”

People who used relievers only were more likely to be younger and male.

The survey showed that 23% had had urgent treatment for their condition in the past year, and just over 70% of these were suffering symptoms consistent with poorly controlled asthma.

“This urgent healthcare group tended to be really frustrated with their asthma and unhappy with how they were managing it,” Prof Reddel says.

They were also more likely to live in fear of a severe asthma attack despite taking their reliever medication as instructed, and also more likely to try to manage worsening asthma themselves rather than see a doctor—even though they doubted their ability to intervene early to prevent their symptoms worsening.

Prof Reddel told the AJP that pharmacists are instrumental in keeping an eye out for people who frequently buy reliever medications.

“Apart from frequent symptoms, the risk factors for a severe flare-up include having had a flare-up in the last 12 months, and not being on a preventer,” she says.

“People with confirmed food allergy, pregnant women and people who have ever been in intensive care for asthma are also at risk.

“There’s good evidence that having three or more reliever inhalers dispensed in a year is a flag for an increased risk of flare-ups.

“And getting a reliever inhaler once a month indicates that you’re at increased risk of dying of asthma.”

“If you have symptoms more than twice a month, or any risk factors for flare-ups, you should be on a preventer inhaler.”

Prof Reddel says that it’s clear that doctors and other health professionals are currently failing to capitalise on opportunities to help these patients – but pharmacists are in a very good position to help.

Pharmacists are a “key” point of contact with people who have asthma, “because even if they don’t see their GP, they can get Ventolin and other short-acting beta agonists over the counter in Australia, so pharmacy may be their only point of contact with health professionals about their asthma”.

Patients may be unwilling to discuss their asthma at the point of purchase of Ventolin and other relievers, she says, so it’s important to try to avoid easily-brushed-off questions such as “do you know how to use your inhaler,” or “have you used this before”.

“They’ll just say yes, I’ve been taking it for decades, don’t bother me,” Prof Reddel says. “So you have to adapt it to the patient themselves.

“The Asthma Score has five quick questions including the frequency of symptoms and night waking, that sort of thing, that can be asked very quickly. You should also ask if they have had a flare-up in the last 12 months.

“Pharmacists also have a key role in inhaler technique and identifying patients with poor adherence, and there’s very good evidence about the role they can have there.”

Ice-breakers such as the link between hayfever symptoms and asthma now that it’s spring, and last year’s thunderstorm asthma event in Melbourne – in which many people who had not previously only had allergic rhinitis and not asthma attack were affected – may also help pharmacists start a conversation.

“A lot of people with allergic rhinitis or hayfever might have some wheezing when they have hayfever symptoms, and assume it’s just part of the hayfever, but it’s not – it’s that they also have asthma,” Prof Reddel says.

“In Australia, almost everyone who has allergic rhinitis and has wheezing with it, has asthma present all year, even if they have no symptoms at other times of the year.”

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