Over-use of short-acting inhalers for uncontrolled asthma

Abstract

Why asthma still kills is the National Review of Asthma Deaths' first national investigation of asthma deaths in the UK and the largest study worldwide to date (Royal College of Physicians (RCP), 2015). The primary aim was to understand the circumstances surrounding asthma deaths to identify avoidable factors and make recommendations to improve care and reduce the number of deaths.
Some of the recommendations involve prescribing and medicines use. One of these specifically states, ‘All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment, if required’ (RCP, 2015).
The reason for this is that over-use of short-acting relievers can be an indication of uncontrolled asthma. An additional concern due to over-use can be explained by the pharmacology of short-acting relievers. These medicines, such as salbutamol and terbutaline, are beta-2 receptor agonists, and their over-use can lead to the ‘down-regulation’ of receptors, which can result in an insufficient therapeutic effect in an emergency situation (Joint Formulary Committee, 2016). Furthermore, the over-use of medicines can lead to side effects (e.g. palpitations or anxiety), and is a waste of NHS resources.