SABA Prescriptions and Asthma Management Practices in Singapore: Results from a Cross-sectional, Observational SABINA III Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Jun 10

PMID 38858145

Authors

David Hsien Yung Tan

Tze Lee Tan

Wee Hian Tan

Cheryl Choong

Maarten J H I Beekman

Joanne Huiyi Khor

S Suraj Kumar

Geraldine Ruining Wong

Hui Fang Lim

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate asthma characteristics and treatment patterns, including short-acting β-agonist (SABA) prescriptions, in primary and specialist care in the Singapore cohort of the SABA use IN Asthma (SABINA III) study.

Design: Cross-sectional, observational study.

Setting: Multicentre study conducted at five sites across Singapore.

Methods: In patients with asthma (aged ≥12 years), data on demographics, disease characteristics and asthma treatment prescriptions were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by 2017 Global Initiative for Asthma recommendations) and practice type (primary/specialist care).

Results: Of the 205 patients analysed (mean (SD) age, 53.6 (16.8) years; female, 62%), 55.9% were enrolled by specialists and 44.1% by primary care physicians. Most study patients (80.5%) had moderate-to-severe asthma (86.0% in specialist care and 74.4% in primary care). In the 12 months before study enrolment, 18.0% of patients experienced ≥1 severe exacerbation. Asthma was well or partly controlled in 78.0% of patients. Overall, 17.1% of all patients were overprescribed SABA (≥3 SABA canisters/year) in the preceding 12 months, and overprescription was greater in specialist versus primary care (26.3% vs 5.6%). Only 2.9% of patients were prescribed SABA monotherapy, while 41.0% received SABA in addition to maintenance therapy. Among the latter, 40.5% were overprescribed SABA. Overall, a higher percentage of patients prescribed ≥3 SABA canisters (vs 0-2 SABA canisters) were assessed as having uncontrolled asthma during the study visit (42.9% vs 17.6%). Maintenance therapy in the form of inhaled corticosteroids (ICS) or ICS/long-acting β agonist fixed-dose combinations were prescribed to 14.1% and 84.9% of patients, respectively, in the 12 months before enrolment.

Conclusions: In this Singapore cohort, ~17% of all patients and more than 40% of patients prescribed SABA in addition to maintenance therapy were overprescribed SABA. These findings emphasise the need to align clinical practices with the latest evidence-based treatment recommendations.

Trial Registration: NCT03857178.

Citing Articles

Asthma prescribing trends, inhaler adherence and outcomes: a Real-World Data analysis of a multi-ethnic Asian Asthma population.

Toh M, Ng G, Goel I, Lam S, Wu J, Lee C NPJ Prim Care Respir Med. 2024; 34(1):35.

PMID: 39489762 PMC: 11532544. DOI: 10.1038/s41533-024-00391-w.

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