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Excessive use of inhalers may increase the risk of asthma attacks, study suggests

A recently published study showed that the excessive and inappropriate use of a type of asthma inhaler he can increase the risk of serious disease reactions , causing harm to health. The conclusion was made after analyzing data collected in the Northeast, Central-West and Southeast regions of Brazil, in public and private services.

The research is part of a global study called SABINA (“SABA use IN Asthma“, which means “Use of SABA in asthma”, in literal translation from English), sponsored by the biopharmaceutical company AstraZeneca. The section with isolated data from Brazil was published in the Brazilian Journal of Pulmonology earlier this year.

This is the first study to analyze drug prescribing practices KNOW (short-acting beta2 agonist), a type of pump consisting of a short-acting inhaled bronchodilator indicated for the rapid relief of asthma symptoms. The medication works by dilating the bronchi, allowing air to pass through during episodes of crisis.

This kind of firecracker should not be indicated for long-term treatment of the disease . However, the study showed that there is an excessive prescription of this type of treatment in Brazil and that this may be related to the worsening of asthma in patients, leading to the need for the use of oral corticosteroids — which can cause side effects and long-term health risks.

Asthma is one of the most common respiratory diseases in Brazil, according to the Ministry of Health. Its main characteristics are difficulty breathing, wheezing and tightness in the chest and short, rapid breathing. Environmental and genetic factors may be related to the development and worsening of the disease, such as exposure to dust, mites and fungi, climate variations, viral infections, family history and obesity.

How was the study carried out?

To reach the conclusion, the researchers analyzed 218 asthmatic patients, who answered questions about the use of inhalers to treat the disease. Of the total participants, 80.3% were prescribed SABA in addition to maintenance therapy, with an average use of 11.2 doses of the medication in the 12 months prior to the survey. Of these, 71.4% received a prescription equal to or greater than 3 vials and 42.2%, greater than or equal to 10 vials.

The study also showed that 49.1% of patients undergoing treatment with this type of pump had one or more severe exacerbations of the disease increasing the inflammation caused by asthma.

These findings corroborate with previous evidence which show that excessive use of SABA can increase the risk of serious manifestations of the disease.

“The results of this study are worrying and reveal a pattern of SABA prescription that deviates from the recommendations established in the medical literature. Excessive use of these medications can lead to a lack of awareness of the severity of the disease and, what is even more alarming, to the need for more aggressive treatments with oral corticosteroids”, says Marcelo Rabahi, professor of pulmonology at the Faculty of Medicine at UFG ( Federal University of Goiás) and one of the study researchers.

Risk is related to inappropriate use of pumps with bronchodilators

Rabahi emphasizes that the worsening of asthma is related only to the improper and excessive use of the SABA-type pump .

“We don’t want people to stop using this type of firecracker, because, for some situations, its use is really necessary”, says Rabahi to CNN . “The problematic issue is its inappropriate use as a form of asthma treatment. These pumps made up of bronchodilators alone are not used to treat the disease, but rather to alleviate symptoms only in times of crisis”, he adds.

Firecrackers are inhaled medicines whose components are available via aerosol (spray) or in the form of “dry powder inhalers” (DPIs) and there is a wide variety of these medicines. The SABA type, which consists of only a short-acting bronchodilator, is indicated for the quick relief of crises and does not act to treat the cause of the disease, which is inflammation of the bronchi.

Long-term treatment must be carried out with the use of inhaled corticosteroid pumps, which may or may not be associated with long-acting bronchodilators.

“It is essential that healthcare professionals are aware of these issues and follow the recommended clinical guidelines for the treatment of asthma”, he highlights.

What could be related to the overprescription of short-acting bronchodilator pumps?

One of the highlights of the study was the excessive prescription of short-acting bronchodilator pumps despite their contraindication for the long-term treatment of asthma. In the view of Gustavo Prado, pulmonologist at Hospital Alemão Oswaldo Cruz, who was not involved in the study, this can be explained by “a certain latency in the incorporation of more current knowledge about asthma among doctors working in primary health care”.

Furthermore, he explains that self-medication with short-acting bronchodilator pumps may also be associated with difficulty in accessing control medications, which are generally high-cost, or the patient's lack of access to health services for an evaluation. more appropriate.

“Sometimes, given the complexity of the interactions between socioeconomic and health determinants, especially in more vulnerable parts of the population, these factors can overlap. But it is important to remember: the Ministry of Health provides all medicines free of charge”, he highlights.

What would be the solution then?

Since 2019, the Global Initiative for Asthma (GINA) Steering Committee recommends the use of bronchodilators associated with inhaled corticosteroids . In 2020, the SBPT (Brazilian Society of Pulmonology and Phthisiology) also recommended, for safety reasons, not to use monotherapy with SABA for the treatment of asthma.

This decision was based on accumulating evidence that SABA monotherapy increases the risk of asthma attacks. In turn, combined use with inhaled corticosteroids can reduce this risk .

“I believe that we should not ask ourselves what the alternatives are for patients, but how they can have access to the best treatments”, says Prado. “I also argue that updating and recycling programs (continuing education) aimed at general practitioners can effectively reduce this gap between treatment recommended by guidelines, which is safer and more effective, and that prescribed incompletely or inappropriately”, he adds.

Source: CNN Brasil

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