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Observational Study
. 2024 Feb 23;50(1):e20230174.
doi: 10.36416/1806-3756/e20230174. eCollection 2024.

Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil

[Article in English, Portuguese]
Martti Anton Antila  1 , Adelmir Souza-Machado  2   3 , Marcelo Gervilla Gregório  4 , Álvaro A Cruz  3   5 , Luciene Angelini  6 , Maarten J H I Beekman  7 , Gilmar Alves Zonzin  8 , Marcelo Fouad Rabahi  9
Affiliations
Observational Study

Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil

[Article in English, Portuguese]
Martti Anton Antila et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil.

Methods: This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy.

Results: Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations.

Conclusions: Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.

Objetivo:: Avaliar os padrões de prescrição de short-acting b2 agonists (SABAs, b2-agonistas de curta duração) e outros medicamentos para asma em pacientes tratados por especialistas e participantes do estudo SABA use IN Asthma (SABINA) no Brasil.

Métodos:: Trata-se de um estudo transversal observacional realizado em cinco locais em diferentes regiões do Brasil. Os desfechos primários foram registrar as prescrições de SABAs e obter dados a respeito da compra de SABAs sem receita médica na farmácia.

Resultados:: Foram analisados dados a respeito de 218 pacientes com asma. Dos 218 pacientes, 80,3% receberam prescrição de SABA além da terapia de manutenção, com uma média de 11,2 frascos de SABA nos 12 meses anteriores. Destes, 71,4% receberam prescrição de ≥ 3 frascos e 42,2% receberam prescrição de ≥ 10 frascos. Nenhum dos pacientes recebeu prescrição de monoterapia com SABA. Do total de pacientes, 14,2% relataram que compraram SABAs sem receita médica na farmácia. Destes, 48,4% compraram ≥ 3 frascos de SABA. Foram prescritas doses fixas combinadas de corticosteroide inalatório e b2-agonista de longa duração para 95,0% dos pacientes. No ano anterior à visita do estudo, 45,0% dos pacientes receberam pelo menos um ciclo de tratamento de curta duração com corticosteroide oral. A asma estava bem controlada em 43,1% dos pacientes, parcialmente controlada em 34,9% e não controlada em 22,0%. Os pacientes relataram uma média de 1,1 exacerbações graves da asma, sendo que 49,1% apresentaram uma ou mais exacerbações graves.

Conclusões:: A prescrição excessiva e a compra de SABAs sem receita médica são comuns no Brasil e possivelmente levam à necessidade de uso de corticosteroides orais. A comunidade de profissionais de saúde deve colaborar para implantar recomendações baseadas em evidências e promover a educação em saúde para melhorar o manejo da asma no Brasil.

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Conflict of interest statement

CONFLICTS OF INTEREST: MAA participated in clinical trials for AbbVie, AstraZeneca, EMS, Eurofarma, GlaxoSmithKline, Humanigen, Janssen, Novartis, Sanofi, and Veru, and received fees for conferences and consultancy activities from Abbott, Aché, AstraZeneca, Chiesi, Eurofarma, IPI ASAC, and Sanofi. ASM gives lectures and develops clinical trials for AstraZeneca and Sanofi; has a project funded by the Brazilian Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, National Council for Scientific and Technological Development); and is an associate professor 4 at the Federal University of Bahia Institute of Health Sciences, located in the city of Salvador, Brazil. MGG develops clinical trials for AstraZeneca. AAC is a professor of medicine at the Federal University of Bahia and the executive director of the ProAR Foundation. He received honoraria for lectures and/or advisory boards from Abdi Ibrahim, AstraZeneca, Boehringer Ingelheim, Chiesi, Crossject, Eurofarma, Glenmark, GlaxoSmithKline, Mylan, Novartis, and Sanofi. LA is an employee of AstraZeneca. MJHIB was an employee of AstraZeneca at the time the study was conducted. GAZ develops clinical trials for AstraZeneca and is an assistant professor of medicine at the Centro Universitário de Volta Redonda, Brazil. MFR was principal investigator of clinical studies for AstraZeneca, Boehringer Ingelheim, and Eurofarma.

Figures

Figure 1
Figure 1. In A, short-acting b2 agonist (SABA) prescriptions, by asthma severity; in B, over-the-counter (OTC) SABA purchases, by asthma severity; and in C, inhaled corticosteroid (ICS) prescriptions, by dose, in the 12 months before the study visit in the SABA use IN Asthma (SABINA) study in Brazil. LABA: long-acting b2 agonist.
See this image and copyright information in PMC

References

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