Excessive Reliever Inhaler Use in Asthma
Research type
Research Study
Full title
Reducing Asthma Exacerbations by using Short-Acting Beta Agonist Prescription Alerts to Target High Risk Children: Patient and Public Involvement and Feasibility Work
IRAS ID
320140
Contact name
Anna Selby
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
0 years, 3 months, 31 days
Research summary
Research Question
Background:
Many children and teenagers have asthma, a long-term lung condition that causes wheezing and breathlessness. Severe asthma attacks may need hospital treatment and can be fatal. Two types of inhalers are used to treat asthma- relievers and preventers. Overuse of reliever inhalers indicates poor asthma control is associated with a higher risk of asthma attacks and death. A 2014 review of asthma deaths in the UK recommended that children and adults should have an urgent check-up if they are prescribed more than 12 asthma reliever inhalers in a year. This does not currently happen routinely; probably because there is not enough evidence that it would benefit patients.Aim:
To establish the knowledge needed to develop a system to flag up children using high numbers of reliever inhalers and develop a protocol for a larger trial looking at whether we can prevent asthma attacks with a nurse-led check-up of these children.Design:
This study will involve the following:1. A short electronic survey will be sent to all GP practices across Hampshire and the Isle of Wight to find out whether they have systems in place to identify asthma patients using high numbers of reliever inhalers.
2. Six general practices will be asked to identify children with asthma and provide details of how many reliever inhalers they have been prescribed in the past year. This will help to establish whether patients using high numbers of inhalers can easily be identified and give an indication of the scale of the problem.
3. Focus group work will be undertaken with general practice staff and children with asthma/their parents to obtain their views on the introduction of alert systems for excessive reliever inhaler use. Focus group members will also be asked to provide feedback on the design of our larger trial.Lay Summary
Two types of inhalers are used to treat asthma: relievers and preventers. Overuse of relievers is associated with a higher risk of asthma attacks. Children prescribed 7 or more in one year are 4-5 times more likely to have a severe asthma attack than children prescribed none. This work was undertaken to inform the design of a study aimed at addressing reliever inhaler overuse in children with asthma. It involved:1. A survey was sent to general practices across Hampshire and the Isle of Wight. 76% of responders reported having electronic alert systems to identify patients being prescribed high numbers of reliever inhalers. However, the nature of these systems varied considerably between practices.
2. Three practices provided data on how many reliever inhalers children with asthma had been prescribed in the past year. On average, 7.6% of children had been prescribed 7 or more reliever inhalers.
3. Interviews were undertaken with health professionals to understand more about asthma reviews in general practice and existing systems for identifying patients at high risk of asthma attacks. They were also asked their views on our proposed study to address reliever inhaler overuse in children.
The findings of this work have been used to develop the protocol for the Prescription Alerts for Reliever inhalers in Children (PARC) project, which is being funded by the National Institute for Health and Research (NIHR). The aim of this is to determine whether targeted, enhanced asthma reviews in children prescribed 7 more reliever inhalers in a year can prevent severe asthma attacks.
REC name
Wales REC 5
REC reference
23/WA/0200
Date of REC Opinion
5 Jul 2023
REC opinion
Favourable Opinion