Optimising Asthma Management: Addressing SABA Overuse and Inhaler Technique in Australia

Asthma is a common chronic condition in Australia, affecting one in ten Australians. Despite the availability of effective pharmacological treatments, asthma is still poorly managed for many individuals. This results in preventable asthma flare-ups, exacerbations, and healthcare costs. A major factor contributing to poor asthma control is the overuse of short-acting beta-agonists (SABAs) and inadequate adherence to maintenance therapies. In addition to this, incorrect inhaler technique can further diminish the effectiveness of treatment.

Understanding Asthma

Asthma is a chronic disease characterised by shortness of breath, wheezing, coughing, and increased mucus production. The primary goals of asthma treatment are to control symptoms and reduce risks such as exacerbations and lung function decline. Achieving good asthma control not only improves the patient’s quality of life but also reduces the likelihood of asthma attacks.

Good asthma control is defined by:

  • Daytime symptoms occurring two or fewer days per week
  • The need for a reliever on two or fewer days per week
  • No limitations on daily activities
  • No asthma symptoms during the night or upon waking

Dangers of Poor Asthma Management

Poor asthma management can lead to a range of complications, including increased risk of exacerbations, reduced quality of life, and higher healthcare utilisation. Individuals with poorly controlled asthma may experience frequent flare-ups, debilitating symptoms, and reduced productivity. A history of exacerbations also raises the risk of future attacks, underscoring the importance of maintaining proper asthma control.

Asthma Treatment Guidelines

According to the Australian Asthma Handbook, asthma management should follow a stepped approach, particularly for adults. Most patients require low-dose inhaled corticosteroids (ICS) as a regular preventer, combined with an as-needed SABA for symptom relief. If this regimen does not provide good control, treatment may be escalated to a combination of low-dose ICS and a long-acting beta-agonist (LABA). However, it is critical to reassess the patient’s adherence to their current treatment and their inhaler technique before making any adjustments.

Inhaled corticosteroids are the most effective therapy for reducing asthma symptoms, exacerbations, and airway remodelling. They work to manage the underlying inflammation that causes asthma. While some patients may require the addition of a LABA, the use of LABAs without corticosteroids should be avoided due to the increased risk of asthma-related death.

Short Acting Beta Antagonists (SABAs)

SABAs are commonly used as relievers to provide rapid relief from acute asthma symptoms. They are effective bronchodilators that relax the muscles around the airways, allowing for easier breathing. Common SABAs include Salbutamol (Ventolin, Asmol, Airomir) and Terbutaline (Bricanyl). However, while SABAs can alleviate symptoms quickly, they do not address the inflammation that triggers asthma.

Risks of SABA Overuse

SABA overuse is a significant problem, with more than half of asthma-related deaths linked to overuse of reliever medication. Using a SABA more than twice a week is a marker of poor asthma control and a predictor of future exacerbations and asthma-related deaths.

The more SABA inhalers a person uses per year, the greater their risk of hospital admission and even death. Specifically, using more than three SABA inhalers annually is associated with a higher risk of hospitalizations due to asthma. Alarmingly, more than 40% of asthma deaths have been linked to SABA overuse.

Frequent use of SABAs, especially without the proper use of ICS, can paradoxically increase airway hyper-responsiveness, making asthma symptoms worse over time. This heightened sensitivity can lead to life-threatening exacerbations.

Overuse can also mask the true severity of asthma, leading to undertreatment. It’s crucial to recognize that while SABAs provide temporary relief, they do not treat the underlying cause of asthma, which is inflammation. Only consistent use of preventer medications like ICS can manage this inflammation and reduce the risk of severe asthma attacks.

Proper Inhaler Technique

Even when using the correct medications, poor inhaler technique can significantly impact asthma control. In fact, studies show that up to 90% of people do not use inhalers correctly. For Metered Dose Inhalers (MDIs), using a spacer is essential to ensure the medication reaches the lungs effectively.

Here’s a step-by-step guide for using an MDI with a spacer:

  1. Assemble the spacer.
  2. Remove the inhaler cap and shake the inhaler well.
  3. Insert the inhaler upright into the spacer.
  4. Seal your lips around the spacer mouthpiece.
  5. Breathe out gently into the spacer.
  6. Press down on the inhaler canister and breathe in slowly and deeply, or take 3-4 normal breaths.
  7. Remove the spacer from your mouth and breathe out gently.
  8. If another dose is needed, repeat the steps.
  9. Replace the inhaler cap when finished.

For those using a Turbuhaler, follow these steps:

  1. Remove the cover and check the dose counter.
  2. Twist the base of the inhaler until you hear a click.
  3. Breathe out gently (away from the inhaler).
  4. Seal your lips around the mouthpiece without covering the air vents.
  5. Breathe in deeply and remove the inhaler from your mouth.
  6. Breathe out gently (away from the inhaler).
  7. Replace the cover when done.

Good inhaler technique ensures the medication works effectively and reduces the risk of unnecessary exacerbations.

FAQs

How often should I use my reliever inhaler?

If you are using your reliever inhaler (SABA) more than two days a week, this may be a sign that your asthma is not well controlled. You should consult your healthcare provider to review your treatment plan.

What is good asthma control?

Good asthma control means experiencing symptoms two or fewer days a week, needing your reliever on two or fewer days a week, having no limitations on daily activities, and being free from asthma symptoms during the night.

What should I do if my asthma is not well controlled?

If your asthma symptoms persist despite using your reliever, it is important to consult your healthcare provider to reassess your asthma management plan. You may need to adjust your preventer medication or review your inhaler technique.

Key Takeaways

  • The hallmark of asthma is chronic airway inflammation, and inhaled corticosteroids (ICS) are crucial for managing this condition.
  • Using a SABA more than twice a week indicates poor asthma control and should prompt a review of the treatment plan.
  • Over-reliance on SABAs can lead to an increased risk of asthma-related deaths and exacerbations.
  • Proper inhaler technique is vital for ensuring the medication reaches the lungs and works effectively.

Summary

Asthma management in Australia requires careful attention to both medication adherence and proper inhaler technique. Over-reliance on SABAs without consistent use of inhaled corticosteroids can lead to poor asthma control, increasing the risk of exacerbations and hospitalizations. By following treatment guidelines and using inhalers correctly, most individuals can achieve good asthma control and improve their quality of life.

For more information on asthma management and proper inhaler use, consult with Webstercare today.