Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands.
Respir Med. 2024 Sep;231:107723. doi: 10.1016/j.rmed.2024.107723. Epub 2024 Jun 25.
Short-acting β-agonists (SABA) overuse is associated with poor asthma control. The Global Initiative for Asthma (GINA) 2019-updated strategy report has therefore taken a paradigm shift in reliever therapy recommendations.
(I) To investigate the status of SABA overuse and medication dispensing patters in asthma in the Netherlands (II) validate dispensing data for SABA overuse identification and (III) understand patients' perspectives towards this SABA-taking behavior to inform future improvement strategies.
An annually repeated cross-sectional study was conducted from 2017 to 2021 using pharmacy dispensing data in a real-world setting, including asthma patients aged 18-45 with ≥1 inhaler. A following qualitative study was performed in identified SABA overusing patients with a questionnaire and semi-structured interviews, supported by theoretical frameworks.
Dispensing data was available from 87 % of all community pharmacies (n = 1994) in 2017 and 95 % (n = 2005) in 2021. SABA overuse prevalence was constant for the five study-years with 20.6 % (±0.5 %). Increased ICS-formoterol and decreased SABA dispenses were observed in starters of inhalation therapy in 2021. 53 asthma patients completed the questionnaire of whom 43 patients confirmed SABA overuse, generating a positive predictive value of 81 %. Key behavioral drivers covered 7 themes regarding capability (knowledge; skills; memory, attention and decision process) motivation (emotion; beliefs about-capabilities; consequences) and opportunity (environmental context).
SABA overuse remains in one-fifth of asthma patients across the Netherlands, requiring careful attention from healthcare professionals. Dispensing data is a valid measure for SABA overuse in a clinical setting, facilitating patient selection. To meet patients' varied supporting needs, integration of tailored behavioral interventions is essential.
短效 β-激动剂（SABA）的过度使用与哮喘控制不佳有关。因此，全球哮喘倡议（GINA）2019 年更新的策略报告在缓解治疗建议方面采取了范式转变。
（I）调查荷兰哮喘中 SABA 过度使用和药物配给模式的现状；（II）验证 SABA 过度使用识别的配药数据；（III）了解患者对这种 SABA 使用行为的看法，为未来的改进策略提供信息。
使用真实环境中的药房配药数据，从 2017 年至 2021 年每年进行一次横断面研究，包括年龄在 18-45 岁之间、至少使用一种吸入器的哮喘患者。在确定的 SABA 过度使用患者中进行了一项定性研究，采用问卷和半结构化访谈，并辅以理论框架。
2017 年，所有社区药房（n=1994）中有 87%提供了配药数据，2021 年为 95%（n=2005）。在五个研究年度中，SABA 过度使用的患病率保持不变，为 20.6%（±0.5%）。2021 年，开始吸入治疗的患者中，ICS-福莫特罗的使用增加，SABA 的使用减少。53 名哮喘患者完成了问卷，其中 43 名患者确认了 SABA 过度使用，阳性预测值为 81%。关键行为驱动因素涵盖了关于能力（知识；技能；记忆、注意力和决策过程）、动机（情感；对能力的信念；后果）和机会（环境背景）的 7 个主题。
在荷兰，有五分之一的哮喘患者存在 SABA 过度使用的情况，需要医护人员的密切关注。配药数据是临床环境中 SABA 过度使用的有效衡量标准，有助于患者的选择。为了满足患者不同的支持需求，整合量身定制的行为干预措施至关重要。
