Introduction
Methods
Study Design
Participants
Results
Phase 1
Phase 2
Phase 3
Gathering information on disease and SABA reliever medication use | Median Likert score (IQR) |
---|---|
1. The ACT or ACQ or another validated asthma control survey should be used as part of routine assessment of patients with asthma. | 5 (5–5) |
2. The amount of a patient’s rescue medication use should be part of their asthma medical history evaluations. | 5 (5–5) |
3. For patients who have been prescribed SABA rescue medication (e.g., albuterol) for asthma, information about previous rescue medication use in the prior weeks or months should be obtained at every visit. | 5 (5–5) |
4. Patient history should be used to assess SABA rescue medication use for patients with asthma. | 4.5 (4–5) |
5. Clinicians should solicit information on frequency of SABA use at every encounter with an asthma patient. | 5 (4.75–5) |
6. Pharmacy refill data could be used to assess SABA reliever medication use for patients with asthma; however, these data may not correlate with actual SABA reliever use. | 4 (4–4.25) |
7. Digital health tools should be used to assess SABA rescue medication use for patients with asthma. | 4 (4–5) |
8. A patient’s asthma rescue medication use should factor into clinical decision-making for asthma management. | 5 (4–5) |
9. A better understanding of SABA rescue medication overuse should play a role in shared decision-making between patients with asthma and healthcare professionals in the United States. | 4 (4–5) |
Patient SABA use history | |
10. Patient SABA use history is generally accurate, but other information (e.g., validated questionnaires, refill data, digital recorders) should be used to obtain accurate information on the patient’s SABA use since their previous visit. | 4 (4–4.25) |
11. The accuracy of patient SABA use history is variable, and its use should depend on the patient. | 4 (4–4) |
12. The accuracy of patient SABA use history may be inaccurate and therefore should not be used as the sole determinant of the patient’s SABA use. | 5 (5–5) |
13. SABA reliever use frequency as gathered in patient history plays a role in the assessment of a patient’s asthma control. | 4 (4–4.25) |
14. SABA reliever use frequency plays a role in the assessment of a patient’s asthma control. The reliability of the information utilized should be taken into consideration. | 4.5 (4–5) |
SABA reliever medication prescribing | |
15. Patients should have SABA refills available, but refill rates should be monitored closely. Use of 3 or more canisters a year is associated with an increased risk of exacerbations and asthma related death. | 5 (4.75–5) |
Levels of SABA reliever medication use | |
If a patient exceeds the level of SABA rescue medication use you feel is appropriate, they may be at risk of | |
16. Loss of asthma control | 4.5 (4–5) |
17. An impending or experiencing an ongoing asthma exacerbation | 4 (4–5) |
18. An impending, urgent, emergent or hospital visit for asthma | 4 (4–5) |
19. Inappropriate SABA use | 4 (4–4) |
20. Experiencing inhaler technique challenges | 4 (4–4.25) |
If a patient exceeds the level of SABA rescue medication use you feel is appropriate, they are likely to be at risk of | |
21. Loss of asthma control | 4 (4–5) |
22. An impending or experiencing an ongoing asthma exacerbation | 4 (4–5) |
23. An impending urgent, emergent or hospital visit for asthma | 4 (4–5) |
Exacerbations | |
24. The use of SABA reliever medication 2–3 times per week may represent an impending or ongoing asthma exacerbation. The magnitude of an individual’s increase above their baseline in reliever SABA use is important and clinical correlation is essential. | 4 (4–5) |
The following amount of weekly SABA rescue medication use likely represents an impending or ongoing asthma exacerbation: | |
25. 5 or more episodes of SABA rescue medication use per week | 4.5 (4–5) |
26. 7 or more episodes of SABA rescue medication use per week | 5 (4–5) |
27. 10 or more episodes of SABA rescue medication use per week | 5 (4.75–5) |
28. 15 or more episodes of SABA rescue medication use per week | 5 (4.75–5) |
29. 20 or more episodes of SABA rescue medication use per week | 5 (5–5) |
30. 25 or more episodes of SABA rescue medication use per week | 5 (5–5) |
31. The patient’s baseline SABA rescue medication use should be considered when determining whether the current weekly use may indicate an impending or ongoing exacerbation. | 4 (4–4.25) |
32. If the patient’s current SABA rescue medication use is 50% higher than their baseline use, this likely represents an impending or ongoing exacerbation. | 4 (4–4) |
33. If the patient’s current SABA rescue medication use is 100% higher than their baseline use or more, this likely represents an impending or ongoing exacerbation. | 5 (4.75–5) |
34. The pattern of SABA use over time should play a role in determining whether SABA rescue medication use might represent an exacerbation. | 4 (4–5) |
35. The patient’s SABA rescue medication use pattern over time is more useful than an average of weekly SABA rescue medication use for determining whether a patient may be experiencing an impending or ongoing exacerbation. | 4 (4–4.25) |
36. Valid historical data about night-time SABA asthma rescue medication use should factor into a clinician’s level of concern about asthma exacerbations. | 4 (4–4.25) |
37. If it were possible, knowing of an impending exacerbation days in advance would allow for an outpatient medication intervention that could prevent the exacerbation. | 4.5 (4–5) |
Disease control | |
38. The patient’s baseline SABA rescue medication use should be considered when determining whether the current weekly use may indicate a loss of asthma control. | 4 (4–4.25) |
39. The pattern of SABA use over time should play a role in determining whether SABA rescue medication use might represent a loss of asthma control. | 4 (4–4) |
40. The patient’s SABA rescue medication use pattern over time is more useful than an average of weekly SABA rescue medication use for determining loss of asthma control. | 4 (4–4) |
41. SABA rescue medication overuse could indicate suboptimal effectiveness of a patient’s asthma maintenance therapy. | 4 (4–4) |
There is a correlation between overuse of SABA rescue medications and | |
42. ER visits | 4 (4–4) |
43. Hospitalizations | 4 (4–4) |
44. Unscheduled office/practice visits | 4 (4–4.25) |
45. Increased healthcare costs | 4 (4–4) |
46. Missed work/school | 4 (4–4) |
Clinical actions and SABA reliever medication use levels | |
47. Additional information gathering via phone/portal should be considered if a patient is overusing their SABA rescue medication. | 4 (4–5) |
48. A medication change should be considered if a patient is overusing their SABA rescue medication. | 4.5 (4–5) |
49. An asthma education refresher should be considered if a patient is overusing their SABA rescue medication. | 4 (4–5) |
50. Inhaler technique training should be considered if a patient is overusing their SABA rescue medication. | 5 (5–5) |
51. Clinical actions in response to a patient’s use of their SABA reliever medication should not depend on a specific threshold but rather an increase from the patient’s baseline use. | 5 (4.5–5) |
52. If the current SABA rescue medication use is 100% higher or more than the patient’s baseline, this should warrant additional clinical action. | 5 (4.75–5) |
The following should influence the decision about how to respond to a patient’s SABA rescue medication overuse: | |
53. Severity of symptoms | 5 (4.75–5) |
54. Disruption of activities | 4.5 (4–5) |
55. History of exacerbations | 5 (4–5) |
56. Reports of healthcare utilization (e.g., urgent care, ER, hospitalization) | 5 (5–5) |
57. History of ICU care | 5 (5–5) |
58. Level of disease control | 5 (4–5) |
59. Adherence history | 5 (4.75–5) |
The following should be considered for patients identified as overusing their SABA rescue medication: | |
60. Additional asthma specialty care | 4.5 (4–5) |
61. Additional inhaler training | 4.5 (4–5) |
62. Additional asthma education | 4.5 (4–5) |
An appropriate outpatient asthma therapeutic intervention for a patient with asthma demonstrating excessive SABA rescue medication use could result in | |
63. Better disease recognition | 4 (4–4.25) |
64. Improved asthma education | 4 (4–4.25) |
65. Enhanced asthma control | 4.5 (4–5) |
66. Reduction in asthma exacerbation severity | 4.5 (4–5) |
67. Improved quality of life | 4.5 (4–5) |
68. Lessened risk of asthma death | 4 (4–5) |
69. Improved work/school productivity | 4 (4–4.25) |
Socioeconomic status and SABA reliever medication | |
70. SES influences a patient’s need for SABA rescue medication use. | 4 (4–4) |