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Overuse of short-acting beta-2-agonists in bronchial asthma in Russia

The international scientific journal Journal of Asthma and Allergy published an article "SABA abuse in Russia - burden and possible causes: analysis of the Russian population included in the SABINA III study", which highlights the results of a study of real clinical practice of Russian patients with bronchial asthma (BA), receiving therapy with SABA (short-acting beta-2-agonists). The study showed that in Russia there is a high level of excessive prescription of SABA, which may be correlated with the problem of inadequate control of the course of bronchial asthma and the occurrence of frequent severe exacerbations. The frequency of SABA overuse was not associated with disease severity.

The study analyzed data from 618 Russian patients with asthma older than 12 years. The analysis was carried out in the framework of the SABINA III study (SABA use IN Asthma - the use of SABA in bronchial asthma)1. Most of the study population consisted of patients with moderate and severe degrees of bronchial asthma (78.5%), while a mild degree of the disease was observed in 21.5% of patients. In 36.1% of the observed patients, the course of BA was uncontrolled, and in 33.5% it was partially controlled. More than 80% of the studied patients received a fixed combination of ICS/LABA (inhaled glucocorticosteroid + long-acting beta-2-agonist). Over the past 12 months, almost half of all patients (47.0%) had at least one severe exacerbation of asthma.

Excessive administration of SABA (3 inhalers per year or more) was recorded in 37% of the studied patients. The frequency of overuse of SABA was comparable in patients with mild asthma (35%) and in patients with moderate and severe asthma (38%). During the year, 30.1% of all patients purchased SABA without a prescription, and 14% of patients received three or more SABA inhalers. Approximately 91% of patients who purchased SABA without a prescription ended up receiving prescriptions, and 59% of these patients were prescribed three or more inhalers per year.

Sergey Nikolayevich Avdeev, Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Chief Freelance Pulmonologist of the Ministry of Health of the Russian Federation, Head of the Department of Pulmonology, First Moscow State Medical University named after I.M. Sechenov” of the Ministry of Health of the Russian Federation, noted: “The abuse of emergency* inhalers is due to the fact that patients with asthma mistakenly believe that they are the main component of treatment, however, such inhalers only relieve the symptoms of the disease, but do not eliminate its cause - inflammation. In addition, although many asthma patients are seen by specialized specialists such as pulmonologists and allergists, most asthma patients see primary care physicians who are not always familiar with the latest clinical guidelines for asthma management and may too often appoint KDBA. That is why it is very important to raise awareness not only of patients, but also of doctors about modern methods of treating bronchial asthma. Today, in accordance with the latest international and Russian recommendations, all adults and adolescents with asthma are recommended to use symptomatic or regular anti-inflammatory therapy (low doses of inhaled glucocorticosteroids) to reduce the risk of severe exacerbations. According to the international GINA guidelines, the use of IGCS-formoterol is the preferred treatment option2, SABA monotherapy is no longer recommended2,3.

Sources:

1. Avdeev S, et al. J Asthma Allergy. 2022 Mar 24;15:371-379.
2. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2021. [Electronic resource]. 01/26/2022 URL: http://www.ginasthma.org.
3. Clinical recommendations "Bronchial asthma" 2021 Russian Respiratory Society (RRS). [Electronic resource]. 04/12/2022 URL: https://cr.minzdrav.gov.ru/.

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*A short-acting short-acting inhaler is an inhaler containing short-acting bronchodilators: salbutamol or fenoterol and/or ipratropium bromide, or combinations thereof, and not containing an inhaled glucocorticosteroid.