%0 Journal Article
%T Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial
%A Alison Pritchard
%A Darmiga Thayabaran
%A Dominick Shaw
%A Irene Braithwaite
%A Janine Pilcher
%A Mark Weatherall
%A Mitesh Patel
%A Peter Black
%A Richard Beasley
%A Stefan Ebmeier
%J Archive of "NPJ Primary Care Respiratory Medicine".
%D 2017
%R 10.1038/s41533-017-0032-z
%X Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: >8, >12 and >16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: >16, >24 and >32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48£¿h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48£¿h was 0¡¤94(0¡¤20), 0¡¤94(0¡¤15) and 0¡¤94(0¡¤17), and 0¡¤92(0¡¤19), 0¡¤90(0¡¤26) and 0¡¤94(0¡¤15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48£¿h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435086/