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Expert Consensus on SABA Use for Asthma Clinical Decision-Making: A Delphi Approach.

Njira Lugogo1, Maeve O'Connor2, Maureen George3

  • 1Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. nlugogo@med.umich.edu.

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Summary
This summary is machine-generated.

US experts recommend limiting short-acting beta2-agonist (SABA) prescriptions to fewer than three canisters annually to reduce asthma exacerbation and death risks. Regular SABA use monitoring at every visit is crucial for effective asthma management.

Keywords:
AsthmaAsthma guidelinesDelphi consensusExacerbationsReliever inhalerSABA overuse

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Area of Science:

  • Pulmonary Medicine
  • Clinical Practice Guidelines
  • Asthma Management

Background:

  • Short-acting beta2-agonists (SABA) are cornerstone asthma medications.
  • Current clinical practices for SABA prescription and monitoring vary significantly among US clinicians.
  • Lack of clear consensus guidelines may contribute to suboptimal SABA use and associated risks.

Purpose of the Study:

  • To establish a US expert-led consensus on clinical actions for short-acting beta2-agonist (SABA) use.
  • To guide healthcare providers in managing SABA prescriptions and patient monitoring.
  • To inform future asthma guideline development regarding SABA usage thresholds.

Main Methods:

  • A modified Delphi process involving online surveys, forum discussions, and statement adjudication.
  • Phase 1: Online survey of 100 clinicians to assess current SABA prescribing and monitoring practices.
  • Phase 3: Adjudication by 8 experts to reach consensus on key SABA use recommendations.

Main Results:

  • A significant proportion of clinicians (21%) do not consult asthma guidelines, and 12% routinely prescribe ≥4 SABA canisters annually.
  • Experts reached consensus that ≥3 SABA canisters/year correlates with increased risk of exacerbation and asthma-related death.
  • Consensus also supports soliciting SABA use history at every visit and using usage patterns over time to guide interventions for SABA overuse.

Conclusions:

  • Expert consensus identifies ≥3 SABA canisters/year as a threshold indicating increased risk.
  • Regular solicitation of SABA use history at patient visits is recommended for all asthma patients.
  • Future asthma guidelines should incorporate expert-defined thresholds for SABA usage to prompt clinical action.