Over-reliance on short-acting beta-agonists (SABAs) in asthma: a mixed method study, in primary care, in Greece

Over-reliance on short-acting beta-agonists (SABAs) has been identified as a predictor of poor asthma control and increased asthma-related mortality. The aim of the study was to assess SABA over-reliance and its association with asthma control and the utility of the Reliever Reliance Test (RRT) in addressing SABA over-reliance in primary care patients.

A cross-sectional study was conducted with both quantitative and qualitative data on patients with asthma, in Crete, Greece. Participants completed the Asthma Control Test (ACT) assessing asthma control and were evaluated for their use of SABA. Those who reported SABA use, also completed the RRT which classified patients as low, medium or high-risk of over-reliance. A qualitative survey followed to evaluate the feedback obtained from patients and General Practitioners (GPs) to assess the applicability of RRT.

The study included 145 patients (40 using SABA). Of 38 completing RRT, 82% showed a medium-to-high risk of over-reliance on SABAs, while 24% reported overuse (at least three times/week). The likelihood of poorly controlled asthma significantly increased with greater reliance and more frequent SABA use (OR: 20.209, p = 0.011), and with higher SABA canister use (for ≥1 SABA canister, OR: 2.645, p = 0.026 to ≥3 SABA canisters, OR: 8.372, p = 0.025). Preventive SABA use was reported by 63%, while 86% were unaware of side effects. RRT demonstrated good reliability (Cronbach's alpha 0.835) and validity. Qualitative data suggested that both patients (n = 27) and GPs (n = 11) found RRT acceptable and helpful in addressing SABA over-reliance. GPs also expressed their intention to incorporate the questionnaire into clinical practice, despite time constraints.

Our findings suggest that over-reliance on SABAs is significantly associated with poor asthma control. Moreover, RRT was successfully translated in Greek, and proved to be reliable; This suggests its potential to facilitate the development of more targeted strategies for identifying and addressing this issue, while also promoting collaborative patient-GP discussions with the aim of achieving optimal asthma outcomes.