Over-reliance on reliever pumps linked to increased risk of asthma attacks
Recent updated global recommendations have overturned decades of asthma care and represent the most significant change in asthma management in over 30 years. This is according to the Global Initiative for Asthma (GINA).
For decades, treatment of asthma has involved two different types of inhalers explains Johannesburg-based GP, Doctor Marlin McKay who practices at the Goldman Medical Centre: “Many asthmatic patients use a maintenance inhaler which contains an anti-inflammatory medicine; they also use a symptom reliever inhaler which is blue in colour and contains an item which opens up the airways also known as short-acting beta2 agonists (SABA). 1,2 Asthma patients frequently underuse anti-inflammatory maintenance therapy and instead, over-rely on SABA reliever therapy which provides rapid and temporary relief. The problem with this approach is it can mask the worsening of symptoms and actually increases the risk of asthma attacks.”3-6
The link between SABA blue reliever inhalers over-reliance and an increased risk of asthma attacks has led to updated recommendations from GINA. These recommendations are provided for people using these specific inhalers and advising them to avoid establishing a pattern of reliance on SABA early in the disease.1
GINA no longer recommends SABA blue reliever inhalers alone as the preferred reliever therapy, and instead recommends the use of a low dose inhaled corticosteroid (ICS)-formoterol therapy as needed as the preferred reliever therapy across all asthma severities.1
This Combination inhaler contains Anti-Inflammatory agent which reduces inflammation in the airways which associated with asthma. To inform asthma patients about the new GINA recommendations a public health campaign has been launched by AstraZeneca globally in partnership with the Global Allergy and Airways Patient Platform (GAAPP) and locally with the National Asthma Education Programme (NAEP©) and Independent Community Pharmacy Association (ICPA). The Break Over-Reliance campaign aims to help people with asthma reduce their risk of asthma attacks. It highlights that just three or more puffs of the blue inhaler per week increases a patient’s risk of asthma attacks. 1-3,7,8
To help asthma patients assess their levels of over-reliance the campaign offers a first-of-its-kind digital assessment tool. Known as the Reliever Reliance Test. This evidence-based questionnaire will empower patients to assess their over-reliance on their blue reliever inhaler, SABA9, by answering five short questions.
Dr Mckay affirms that “many patients feel dependant on their SABA blue inhaler, mistakenly believing this to be the best way to control their symptoms. Having said that, it’s important to understand firstly what over-reliance looks like, and this is where the test comes in. I strongly urge that everyone living with asthma should take the test – it’s easy to navigate and will help them understand whether they are relying too heavily on their SABA. If the results indicate over-reliance, then that information can facilitate conversations with their health care professional around their asthma management.
“Recognising that the use of SABA blue inhalers to control asthma symptoms actually increases the risk of asthma attacks1,10,11 – action to correct asthmatic compliance has never been more important. When you consider that South Africa’s prevalence of asthma is among the highest in the world and we are ranked fifth for asthma mortality12, the case for better control is clear.
Khomotso Mashilane, Medical Director: African Cluster, at AstraZeneca adds, “Evidence suggests that healthcare systems are hard-wired to facilitate habitual SABA overuse and over-reliance. Given the recent updates to global asthma management recommendations backed by leading expert opinion, AstraZeneca developed the Break Over-Reliance public health campaign to inform and educate patients, health professionals and policy makers. It centres around the potential dangers of SABA over-reliance and the urgent need to address this issue. As an established leader in respiratory care, we are committed to working with the respiratory community to provide tools that will help improve asthma control and aim to eliminate preventable asthma attacks for the millions of asthma patients in South Africa.”
For more information about the Break Over-Reliance campaign and to take the Reliever Reliance Test, visit www.yes2breathe.co.za or visit our social pages: https://www.facebook.com/yes2breathe and https://www.instagram.com/yes2breathe/
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Notes to the Editor
Asthma is a common chronic respiratory disease, and it affects the health and day-to-day lives of as many as 339 million adults and children worldwide.13 It is an inflammatory disease characterised by recurrent breathlessness and wheezing which varies over time, and which varies in severity and frequency from person to person.1
All asthma patients are at risk of severe attacks, regardless of their disease severity, adherence to treatment or level of control.14-16 There are an estimated 176 million asthma attacks globally per year;17 these attacks may be physically threatening and emotionally significant for many patients. 18 However, despite the fact that asthma is a chronic, variable inflammatory disease, patients often under-use their anti-inflammatory ‘preventer’ therapy and over-rely on their SABA reliever, which can mask symptom worsening.3-6 Taking a SABA inhaler alone does not address the underlying inflammation, leaving patients at risk of an asthma exacerbation. 3-6 and potential exposure to frequent bursts of oral corticosteroids.4,19
The Reliever Reliance Test
The Reliever Reliance Test (RRT) has been developed by leading expert in behavioural medicine, Professor Rob Horne, University College London (UCL), with colleagues from the International Primary Care Respiratory Group (IPCRG) and was fully funded by AstraZeneca UK Limited. The RRT is a five-item questionnaire adapted from the validated SABA Risk Questionnaire, which in turn is a derivation of the validated Beliefs about Medicines Questionnaire (BMQ), also developed by Professor Rob Horne, UCL. 20 The RRT is an evidence-based, practical tool that aims to assess patients’ reliance on their SABA inhaler.9 It is available in both print and digital format. Based on patients’ responses to the five questions, the RRT provides a score indicating whether the patient is likely to be at high, medium or low risk of over-relying on their SABA reliever.4 The score categories and associated feedback are aimed at helping patients understand their attitudes to SABA, and how these attitudes may be causing them to over-rely on their SABA.20 Patients are able to download their results via the digital tool and use them to discuss their asthma control with their HCP.
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