• Anna De Simoni, Hajar Hajmohammadi, Paul Pfeffer, Jim Cole, Chris Griffiths, and Sally A Hull.
• Wolfson Institute of Population Health, Queen Mary University of London, London.
• Br J Gen Pract. 2022 Jun 14; 72 (722): e619e626e619-26.

BackgroundExcess prescription and use of short-acting beta-agonist (SABA) inhalers is associated with poor asthma control and increased risk of hospital admission.AimTo quantify the prevalence and identify the predictors of SABA overprescribing.Design And SettingA cross-sectional study using anonymised clinical and prescribing data from the primary care records in three contiguous East London boroughs.MethodPrimary care medical record data for patients aged 5-80 years, with 'active' asthma were extracted in February 2020. Explanatory variables included demography, asthma management, comorbidities, and prescriptions for asthma medications.ResultsIn the study population of 30 694 people with asthma, >25% (1995/7980), were prescribed ≥6 SABA inhalers in the previous year. A 10-fold variation between practices (<6% to 60%) was observed in the proportion of patients on ≥6 SABA inhalers/year. By converting both SABAs and inhaled corticosteroids (ICSs) to standard units the accuracy of comparisons was improved across different preparations. In total, >25% of those taking ≥6 SABAs/year were underusing ICSs, this rose to >80% (18 170/22 713), for those prescribed <6 SABAs/year. Prescription modality was a strong predictor of SABA overprescribing, with repeat dispensing strongly linked to SABA overprescribing (odds ratio 6.52, 95% confidence interval = 4.64 to 9.41). Increasing severity of asthma and multimorbidity were also independent predictors of SABA overprescribing.ConclusionIn this multi-ethnic population a fifth of practices demonstrate an overprescribing rate of <20% a year. Based on previous data, supporting practices to enable the SABA ≥12 group to reduce to 4-12 a year could potentially save up to 70% of asthma admissions a year within that group.© The Authors.

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