The Feasibility and Impact of Implementing Interventions to Reduce Short-Acting β2-Agonist Over-Reliance in Asthma: An Expert Opinion

Abstract

Asthma poses a significant global health problem. Despite the availability of effective treatments, management practices often fall short of current recommendations. The SABA use IN Asthma (SABINA) programme demonstrated that short-acting β<inf>2</inf>-agonist (SABA) over-reliance significantly contributes to disease burden. A panel of 20 international healthcare practitioners (HCPs) invited to a summit meeting discussed five innovative interventions to reduce SABA over-reliance and assessed the feasibility of implementing them across countries. The interventions included the SABA rEductioN Through ImplemeNting Hull asthma guidELines (SENTINEL) quality improvement programme in the UK, the pay-for-performance (P4P) programme in Taiwan, the Asthma Right Care (ARC) programme in Spain, a SABA-free asthma clinic in Argentina, and a modified emergency department discharge protocol and SABA alert system in the United Arab Emirates. Following a review of the available clinical evidence from these five interventions, the HCPs proposed six themes to tackle SABA over-reliance: (1) consistent delivery of services across healthcare systems in individual countries to facilitate standardisation of optimal treatment approaches and resource allocation; (2) educational initiatives targeted at HCPs and patients to mitigate drivers of SABA over-reliance; (3) adopting a SABA-free treatment paradigm that provides concomitant anti-inflammatory therapy with a fast-acting bronchodilator for symptom relief; (4) regulating over-the-counter SABA purchase without a prescription; (5) engaging policymakers to integrate current evidence-based treatment recommendations into routine clinical practice; and (6) expanding use of digital technology as a key component of a patient-centric approach and monitoring prescribing practices. Since SABAs were the preferred reliever for > 30 years, reducing SABA over-reliance will necessitate a considerable shift in asthma management practices. This transition requires coordinated efforts among clinicians, pharmacists, and policymakers to develop and tailor strategies for raising awareness of the clinical and economic burden of SABA overuse and address local/national barriers to integration of evidence-based recommendations in routine clinical practice.