U.K. issues advisory regarding overuse of asthma reliever drugs

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How much is too much when using your asthma inhaler? The U.K.’s Medicines & Healthcare Products Regulatory Agency (MHRA) recently published a Drug Safety Update that states the overuse of short-acting beta 2 agonists (SABA), such as salbutamol and terbutaline, can lead to serious consequences.

The update emphasizes the importance of using these reliever medications in conjunction with inhaled corticosteroids to prevent severe asthma attacks and increased mortality. Overuse of SABA medications has been linked to severe asthma exacerbations and increased mortality.

According to the agency, a review of 187,675 U.K. primary care records revealed that patients with three or more SABA prescriptions in a year were more likely to experience severe asthma attacks, regardless of their use of anti-inflammatory maintenance therapy.

A report from the U.K. National Child Mortality Database also highlighted the dangers of SABA overuse in children. Of the 54 child deaths due to asthma between April 2019 and March 2023, 87% had an excessive number of reliever inhalers dispensed, and 65% had insufficient preventer inhalers.

The review was completed by the European Union’s Pharmacovigilance Risk Assessment Committee in 2022. Regulatory actions in 2023 strengthened warnings about the risks of masking asthma deterioration with SABA overuse.

The updated asthma guidelines, effective November 2024, no longer recommend prescribing SABA without an inhaled corticosteroid. Instead, most asthma patients should be managed with either anti-inflammatory reliever (AIR) or maintenance and reliever (MART) treatment plans, minimizing the need for SABA.

MHRA issued several recommendations to health care professionals, including:

  • Ensure regular use of preventer medications even when asthma is well controlled.
  • Promptly re-evaluate asthma treatment if a patient’s use of SABA reliever inhalers increases.
  • Review personalized asthma action plans at every asthma assessment to optimize pharmacological treatment.
  • Encourage patients and caregivers to report any adverse drug reactions through Britain’s voluntary reporting adverse drug reaction system, the Yellow Card scheme, which is accessible online and via mobile apps. 
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