SABA over-reliance is a global problem

• “Three or more days a week with required use of a SABA for symptomatic relief ” constitutes a pragmatic threshold for uncontrolled asthma (NICE 2017)
• Most SABA inhalers contain 200 puffs, so in theory this should mean two SABA inhalers a year should be sufficient for a patient who is well controlled. A patient may need a couple of extra inhalers (e.g. to keep at school or in the car)
• Alarm bells should go off when six SABA prescriptions have been collected by a patient in the past six months without a single ICS prescription being issued. Many respiratory specialists argue this should happen sooner i.e. when two or three canisters are prescribed in a 12-month period. What do pharmacists need to be aware of when looking at a patient’s PMR history for SABA use in asthma?
• There is a progressive risk of hospital admission when more than three SABA inhalers are prescribed a year
• Think about electronic alerts. There is evidence that they reduce excessive prescribing of SABAs when delivered as part of a multicomponent intervention.

Use of LABAs

Inhaled corticosteroids and LABAs are commonly prescribed in a single combination inhaler for people with asthma. Inappropriate prescribing of LABAs alone in asthma should always raise an alarm because NRAD and national guidelines all recommend not prescribing a LABA alone. Just like SABAs, LABAs do not treat underlying inflammation and this is considered a safety issue.