High use of short-acting beta-agonist inhalers (SABA) in asthma suggests sub-optimal control and is associated with increased risk of hospitalisation and potentially avoidable asthma deaths (1). The report from the 2014 National Review of Asthma Deaths (NRAD), 'Why Asthma Still Kills', highlights the risks of poor adherence to preventer medication (inhaled corticosteroids (ICS)) and recommends that people using high numbers of SABA inhalers should be invited for urgent review(2). Asthma is associated with inflammation of their airways and this requires treatment with ICS. SABA dilate the airways and relieve symptoms but without an ICS the underlying inflammation continues to narrow the airways leaving the patient susceptible to further symptoms and a possible asthma exacerbation. Good asthma control is associated with little or no need for SABA but people with asthma may perceive that their SABA inhaler is their primary treatment as it is the one that produces immediate symptom relief.
Normalisation of SABA use in asthma needs tackling amongst healthcare professionals, people with asthma and the general public and for asthma outcomes to improve, patients must be educated about the function of each of their inhaler types.
Tackling SABA over-reliance aligns with both the drive to improve asthma control and the drive to reduce the environmental impact of asthma care. This project aims to improve asthma care, and reduce the carbon footprint of asthma care, by educating clinicians and patients on SABA over-reliance and optimising asthma control.
The ARC (Asthma Right Care) intervention we carried out had two components:
1\. An educational session for health care professionals
SABA over reliance, tools to use, key messages about patient understanding of inhalers (see attached documentation for further information)
2\. Targeted education sessions for patients at highest risk from SABA overreliance
Patients identified by system searches to identify those who are using high numbers of SABA inhalers. Implementation of education from above session (see attached documentation for further information).
The focus was about improving clinician and patient understanding of what each of their inhalers does to their lungs and it was postulated that if a patient understands their medicines and what they do, they would be more likely to adhere to inhaled corticosteroids.
In summary 58 clinicians attended the education sessions and the evaluation was excellent showing impact on knowledge and future prescribing habits. 29 patients received the ARC educational intervention. The mean ACT score increased by 4.9 points and all but one patient showed an improvement in their score. Since a change of 2 points suggests significant change in control we showed that the intervention appears to have made a considerable change to the participants asthma control. By embedding the ethos of ARC and this project into standard care the aim is to dramatically reduce SABA over reliance.
