Overuse of Reliever Inhalers Does Not Necessarily Mean Greater Health Care Utilization

Overuse of reliever inhalers among adult patients with asthma is prevalent, but does not necessarily translate into higher all-cause health care utilization (HCU), according to a study published in Scientific Reports.

The Global Initiative for Asthma 2019 guidelines recommend avoiding reliance on reliever inhalers because they increase the risk of exacerbation. The guidance signaled a shift in the use of relievers for managing asthma.

“Controlling asthma and reducing exacerbations requires a balance between controller and reliever medications; however, there is a gap between real-world practice and evidence-based guidelines,” the authors explained. “In addition, adherence rates to controllers are suboptimal, ranging from 15 to 54%.”

The retrospective cohort study was conducted among enrollees of the largest health maintenance organization in Israel with the aim of examining the association between elevated and consistent use of reliever inhalers and corresponding HCU. The study included 977 patients with asthma who were followed up for 6 years.

More than one-fourth (27%) of the patients refilled 3 or more prescriptions of canisters of reliever inhalers during the follow-up. Patients who were consistently refilling 3 or more reliever inhaler canisters annually did not have a higher adherence to maintenance and reliever therapy (MART), but they did have higher adherence to other controllers (0.38 vs 0.24, P < .001).

Patients who consistently refilled 3 or more reliever inhaler canisters annually did not have higher HCU costs than other patients ($5550 vs $5562, P = .107). The researchers found no significant different in the number of emergency department visits between the 2 groups and most other HCU components were comparable as well. Given the higher consumption of medications for the respiratory system, medication costs were higher among the group of patients that consistently refilled 3 or more reliever inhaler canisters annually ($1734 vs $1504, P < .001).

The findings were counter to the authors’ expectations that regular and frequent use of reliever inhalers would be an independent determinant of increased HCU. However, inappropriate use of reliever inhalers was associated with higher adherence to controllers, which was itself associated with increased HCU.

“These results imply that regular and frequent use of reliever inhalers, observed in our study among more than one fourth of the study population, may be a proxy of a more comprehensive phenomenon of inappropriate use of pharmaceutical therapy for asthma management that may indicate uncontrolled asthma, which is associated with elevated HCU costs,” they wrote.

Reference

Hadad R, Likhtenshtein D, Maimon N, Simon-Tuval T. Overuse of reliever inhalers and associated healthcare utilization of asthma patients. Sci Rep. 2020;10(1):19155. doi:10.1038/s41598-020-76280-2.