Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial

Pilcher, Janine; Patel, Mitesh; Pritchard, Alison; Thayabaran, Darmiga; Ebmeier, Stefan; Shaw, Dominick; Black, Peter; Braithwaite, Irene; Weatherall, Mark; Beasley, Richard

Abstract

Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: >8, >12 and >16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: >16, >24 and >32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48 h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48 h was 0·94 (0·20), 0·94(0·15) and 0·94(0·17), and 0·92(0·19), 0·90(0·26) and 0·94(0·15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48 h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen.

Citation

Pilcher, J., Patel, M., Pritchard, A., Thayabaran, D., Ebmeier, S., Shaw, D., …Beasley, R. (2017). Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial. npj Primary Care Respiratory Medicine, 27(1), https://doi.org/10.1038/s41533-017-0032-z

• Journal Article Type: Article
• Acceptance Date: Mar 27, 2016
• Online Publication Date: May 11, 2017
• Publication Date: 2017-12
• Deposit Date: May 30, 2017
• Publicly Available Date: May 30, 2017
• Journal: npj Primary Care Respiratory Medicine
• Electronic ISSN: 2055-1010
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 1
• DOI: https://doi.org/10.1038/s41533-017-0032-z
• Public URL: https://nottingham-repository.worktribe.com/output/860306
• Publisher URL: https://www.nature.com/articles/s41533-017-0032-z
• Contract Date: May 30, 2017