Asthmatics over-using over-the-counter puffers: study

15 August 2019
We are one of the few countries to allow puffers over the counter

For the first time, details about Australians using over-the-counter reliever puffers have been revealed, indicating people may be placing themselves at risk by not getting a diagnosis and taking preventative medication.

Adult Using an Asthma Inhaler. Credit: NIAID via Flickr

Adult Using an asthma Inhaler. Credit: NIAID


Australian asthmatics are overusing reliever medication, according to new research that strongly suggests many are failing to manage their condition.

A study from the University of Sydney and Woolcock Institute of Medical Research reveals for the first-time details surrounding a hidden population of people who buy their reliever puffer over the counter, with concerning results.

More than two thirds of those surveyed overused their reliever, while in contrast a similar number did not use a preventer puffer regularly. Alarmingly, almost one in five people who bought their reliever without a prescription reported they had not been diagnosed with asthma.

The study published today in the prestigious international journal BMJ Open.

Researchers investigated the use in NSW pharmacies of purchases of short-acting beta agonists (SABA), which can be life-saving in acute severe asthma but for which long-term use can be problematic.

Senior author Professor Sinthia Bosnic-Anticevich of the University’s Sydney Medical School and head of the Woolcock’s Quality Use of Respiratory Medicines Group  –  an affiliate of the University of Sydney – said SABA therapy should be carefully restricted to "as needed" usage only.

“We know that using your reliever too much is linked to poor asthma control, increased airway hyper-responsiveness, more asthma-related hospital admissions and, in extreme cases, death. What we really need to understand is why this is happening.

“We absolutely don’t want to ask patients to withhold using their SABA if they need it, but we do need to solve the problem of why they need it or feel they need it,” she said.

“It is critical that we support patients and work with them and their doctors to ensure that asthma flare ups are prevented, and overuse of SABA is not the answer.”

“Results show our concerns about asthma management are real.

“The high proportion of reliever overuse and the low proportion of regular preventer use is in complete contrast to what we would hope to see.

“It’s well-established that one of the key signs of poor asthma symptom control is the need for frequent reliever use. This research indicates that this is common, yet patients don’t seem to be complaining."

Results show our concerns about asthma management are real.
Professor Sinthia Bosnic-Anticevich

Two million Australians - about one in ten - have asthma, a chronic lung condition that inflames and narrows the airways, causing wheezing, shortness of breath, chest tightness and coughing.

The causes are still not well-understood, but triggers are known to include viral infections, exercise, and exposure to allergens and irritants.

Adherence to medications is poor, with many patients failing to use their preventer inhalers regularly, instead relying on reliever medication, the “ambulance-at-the-bottom-of-the-cliff” solution.

Global asthma experts recently moved to officially condemn reliever-only use as a practice associated with high risk.

For the study, the team examined questionnaires completed by 412 people buying SABA over the counter. Results showed 70 percent of participants reported so-called “overuse” of SABA, that is more than the recommended maximum of twice a week within the last four weeks.

“SABA overuse is very high, while preventer medication use remains low, a habit which can lead to poor outcomes and likely explains why only a quarter of over-the-counter purchasers reported well-controlled asthma,” Professor Bosnic-Anticevich said.

“When you consider that there are potentially tens of thousands of people using their medication like this, it suggests that a considerable proportion of Australians are experiencing wheezing, chest tightness and, worse still, asthma flare ups, due to uncontrolled disease.”

The researchers are calling for more work to explore ways in which community pharmacists can identify these uncontrolled asthma patients and refer them onto treatment plans that improve asthma outcomes.

The paper, "Understanding reliever overuse in patients purchasing over-the-counter short-acting beta2 agonists: An Australian community pharmacy- based survey", was a collaboration involving the Woolcock Institute of Medical Research and the University of Sydney, Sydney Local Health District and University of Aberdeen, United Kingdom.

Vivienne Reiner

Media and Public Relations Adviser (Health)

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