For decades, treatment of asthma has involved two different types of inhalers explains Johannesburg-based GP, Doctor Marlin McKay who practices at the Goldman Medical Centre: “Many asthmatic patients use a maintenance inhaler which contains an anti-inflammatory medicine; they also use a symptom reliever inhaler which is blue in colour and contains an item which opens up the airways also known as short-acting beta2 agonists (SABA). 1,2 Asthma patients frequently underuse anti-inflammatory maintenance therapy and instead, over-rely on SABA reliever therapy which provides rapid and temporary relief. The problem with this approach is it can mask the worsening of symptoms and actually increases the risk of asthma attacks.”3-6
The link between SABA blue reliever inhalers over-reliance and an increased risk of asthma attacks has led to updated recommendations from GINA. These recommendations are provided for people using these specific inhalers and advising them to avoid establishing a pattern of reliance on SABA early in the disease.1 GINA no longer recommends SABA blue reliever inhalers alone as the preferred reliever therapy, and instead recommends the use of a low dose inhaled corticosteroid (ICS)-formoterol therapy as needed as the preferred reliever therapy across all asthma severities.1
This Combination inhaler contains Anti-Inflammatory agent which reduces inflammation in the airways which associated with asthma. To inform asthma patients about the new GINA recommendations a public health campaign has been launched by AstraZeneca globally in partnership with the Global Allergy and Airways Patient Platform (GAAPP) and locally with the National Asthma Education Programme (NAEP©) and Independent Community Pharmacy Association (ICPA). The Break Over-Reliance campaign aims to help people with asthma reduce their risk of asthma attacks. It highlights that just three or more puffs of the blue inhaler per week increases a patient’s risk of asthma attacks. 1-3,7,8
Reliever Reliance Test
To help asthma patients assess their levels of over-reliance the campaign offers a first-of-its-kind digital assessment tool. Known as the Reliever Reliance Test. This evidence-based questionnaire will empower patients to assess their over-reliance on their blue reliever inhaler, SABA9, by answering five short questions.
Dr Mckay affirms that “many patients feel dependant on their SABA blue inhaler, mistakenly believing this to be the best way to control their symptoms. Having said that, it’s important to understand firstly what over-reliance looks like, and this is where the test comes in. I strongly urge that everyone living with asthma should take the test – it’s easy to navigate and will help them understand whether they are relying too heavily on their SABA. If the results indicate over-reliance, then that information can facilitate conversations with their health care professional around their asthma management.
“Recognising that the use of SABA blue inhalers to control asthma symptoms actually increases the risk of asthma attacks1,10,11 – action to correct asthmatic compliance has never been more important. When you consider that South Africa’s prevalence of asthma is among the highest in the world and we are ranked fifth for asthma mortality12, the case for better control is clear.
Khomotso Mashilane, Medical Director: African Cluster, at AstraZeneca adds, “Evidence suggests that healthcare systems are hard-wired to facilitate habitual SABA overuse and over-reliance. Given the recent updates to global asthma management recommendations backed by leading expert opinion, AstraZeneca developed the Break Over-Reliance public health campaign to inform and educate patients, health professionals and policy makers. It centres around the potential dangers of SABA over-reliance and the urgent need to address this issue. As an established leader in respiratory care, we are committed to working with the respiratory community to provide tools that will help improve asthma control and aim to eliminate preventable asthma attacks for the millions of asthma patients in South Africa.”
For more information about the Break Over-Reliance campaign and to take the Reliever Reliance Test, visit www.yes2breathe.co.za or visit our social pages: https://www.facebook.com/yes2breathe and https://www.instagram.com/yes2breathe/.
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2020 Update. Available at: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020- report_20_06_04-1-wms.pdf Last accessed July 2020.
- Burki TM. New asthma treatment recommendations. Lancet Respir Med 2019;7:479.
- Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the asthma insights and reality in Europe (AIRE) study. Eur Respir J. 2000; 16: 802–807.
- Tattersfield AE, Postma DS, Barnes PJ, et al. on behalf of the FACET International Study Group. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. Am J Respir Crit Care Med. 1999; 160: 594–599.
- Adams RJ, Fuhlbrigge A, Guilbert T, et al. Inadequate use of asthma medication in the United States: results of the asthma in America national population survey. J Allergy Clin Immunol. 2002; 110: 58–64.
- Larsson, K., Kankaanranta, H., Janson, C. et al. Bringing asthma care into the twenty-first century. NPJ Prim. Care Respir. Med. 2020; 30, 25,
- Asthma UK: Asthma Attacks. Available at: https://www.asthma.org.uk/advice/asthma-attacks/ Last accessed July 2020.
- Asthma UK. Reducing prescribing errors in asthma care. Available at: https://www.asthma.org.uk/support-us/campaigns/publications/nrad-one-year-on/ Last accessed July 2020.
- International Primary Care Respiratory Group. Blue Reliever Reliance Test. Available at: https://www.ipcrg.org/resources/search-resources/blue-reliever-reliance-test-english [Last accessed: July 2020]
- Price D, et al. Asthma control and management in 8,000 European patients: the Recognise Asthma and Link to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24: 14009.
- Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet. 2017; 391: 350-400.
- Global Asthma Report: http://www.globalasthmareport.org/management/southafrica.php#:~:text=High%20mortality,%2 C%20Figures%201%20and%202)
- Global Asthma Network. The Global Asthma Report 2018. [Online]. Available at: globalasthmanetwork.org/publications/Global_Asthma_Report_2018.pdf [Last accessed: July 2020]
- Papi A, Ryan D, Soriano JB, et al. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract 2018; 6: 1989-1998.e3.
- Bloom CI, Nissen F, Douglas IJ, et al. Exacerbation risk and characterisation of the UK’s asthma population from infants to old age. Thorax 2018; 73: 313–320.
- Ding B, Small M. Disease burden of mild asthma: findings from a cross-sectional real-world survey. Adv Ther. 2017; 34: 1109–1127.
- AstraZeneca Pharmaceuticals. Data on file. Annual Rate of Exacerbations Globally (February 2019; ID:SD-3010-ALL-0017).
- Sastre J, Fabbri LM, Price D, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016; 9: 13.
- Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018;11:193–204
- Chan AHY, Katzer C, Kaplan A, et al. SABA Reliance Questionnaire (SRQ): a novel screening tool to identify patients’ beliefs underpinning over-reliance on short-acting beta2 agonists in the management of asthma. J Allergy Clin Immunol Pract. 2020; https://doi.org/10.1016/j.jaip.2020.07.014.