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

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.