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Review
. 2023 Nov;23(11):621-634.
doi: 10.1007/s11882-023-01111-z. Epub 2023 Nov 22.

Expert Consensus on SABA Use for Asthma Clinical Decision-Making: A Delphi Approach

Njira Lugogo  1 , Maeve O'Connor  2 , Maureen George  3 , Rajan Merchant  4 , Greg Bensch  5 , Jay Portnoy  6 , John Oppenheimer  7   8 , Mario Castro  9
Affiliations
Review

Expert Consensus on SABA Use for Asthma Clinical Decision-Making: A Delphi Approach

Njira Lugogo et al. Curr Allergy Asthma Rep. 2023 Nov.

Abstract

Purpose of review: A modified Delphi process was undertaken to provide a US expert-led consensus to guide clinical action on short-acting beta2-agonist (SABA) use. This comprised an online survey (Phase 1), forum discussion and statement development (Phase 2), and statement adjudication (Phase 3).

Recent findings: In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.

Keywords: Asthma; Asthma guidelines; Delphi consensus; Exacerbations; Reliever inhaler; SABA overuse.

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Conflict of interest statement

N. Lugogo received consulting fees from Amgen, AstraZeneca, Avillion, Genentech, GSK, Novartis, Regeneron, Sanofi, and Teva; honoraria for non-speakers bureau presentations from GSK and AstraZeneca; and travel support from Astra Zeneca; her institution received research support from Amgen, AstraZeneca, Avillion, Evidera, Gossamer Bio, Genentech, GSK, Regeneron, Sanofi, Novartis and Teva. She is an honorary faculty member of Observational and Pragmatic Research Institute but does not receive compensation for this role. M. O’Connor has received honoraria and/or consulting fees from AstraZeneca, BioCryst, CSL Behring, GSK, Pharming Technologies BV, Sanofi, and Teva Pharmaceuticals. M. George has received honoraria and/or consulting fees from AstraZeneca, Genentech, Regeneron, Sanofi, and Teva Pharmaceuticals. R. Merchant has received honoraria and/or consulting fees from AstraZeneca, Propeller Health, Teva Pharmaceuticals, and Sanofi. G. Bensch has received honoraria and/or consulting fees from Amgen, Aimimmune, AstraZeneca, Regeneron, Sanofi, and Teva Pharmaceuticals. J. Portnoy has received honoraria and/or consulting fees from BioCryst and Thermo Fisher. J. Oppenheimer has received honoraria and/or consulting fees from Amgen, Aquestive, AstraZeneca, Novartis, GSK, Sanofi, and Regeneron. M. Castro reports institutional grant funding from NIH, ALA, PCORI, AstraZeneca, GSK, Novartis, Pulmatrix, Sanofi-Aventis, and Shionogi. He receives consulting fees from Allakos, Arrowhead, Genentech, GSK, Merck, Novartis, Sanofi-Aventis, Teva and OM Pharma. He receives payment for speaker’s bureau activities for Amgen, AstraZeneca, Genentech, Regeneron, Sanofi-Aventis, and Teva. He receives royalties from Aer Therapeutics and Elsevier.

Figures

Fig. 1
Fig. 1
Study design. *Experts rated statements on a five-point Likert scale, ranging from (1) strongly disagree to (5) strongly agree. SABA, short-acting beta2-agonist
Fig. 2
Fig. 2
Responses to the Phase 1 survey question “In your asthma management practice, which (if any) of the following asthma guideline/expert report recommendations do you routinely use for SABA rescue medication guidance?” 100 US clinicians completed the Phase 1 survey. Participants were required to select the option they most frequently used. ATS, American Thoracic Society; ERS, European Respiratory Society; GINA, Global Initiative for Asthma; NIH/NAEPP, National Institutes of Health/National Asthma Education and Prevention Program
Fig. 3
Fig. 3
Putative framework for clinical application of consensus statements agreed in Phase 3. *ACT/ACQ/patient history are reliant on patient recall and may give inaccurate data. Pharmacy refill data provides a quantitative insight but does not provide information on usage pattern. Digital heath tools can provide an objective real-time dynamic insight into true SABA use. ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; HCRU, healthcare resource utilization; ICU, intensive care unit; QoL, quality of life; SABA, short-acting beta2 agonist
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