Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial
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...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
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Nature Publishing Group
2017
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| Online Access: | https://eprints.nottingham.ac.uk/43274/ |
| _version_ | 1848796651598118912 |
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| author | Pilcher, Janine Patel, Mitesh Pritchard, Alison Thayabaran, Darmiga Ebmeier, Stefan Shaw, Dominick E. Black, Peter Braithwaite, Irene Weatherall, Mark Beasley, Richard |
| author_facet | Pilcher, Janine Patel, Mitesh Pritchard, Alison Thayabaran, Darmiga Ebmeier, Stefan Shaw, Dominick E. Black, Peter Braithwaite, Irene Weatherall, Mark Beasley, Richard |
| author_sort | Pilcher, Janine |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T19:51:22Z |
| format | Article |
| id | nottingham-43274 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:51:22Z |
| publishDate | 2017 |
| publisher | Nature Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-432742020-05-04T18:45:31Z https://eprints.nottingham.ac.uk/43274/ Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial Pilcher, Janine Patel, Mitesh Pritchard, Alison Thayabaran, Darmiga Ebmeier, Stefan Shaw, Dominick E. Black, Peter Braithwaite, Irene Weatherall, Mark Beasley, Richard 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. Nature Publishing Group 2017-05-11 Article PeerReviewed Pilcher, Janine, Patel, Mitesh, Pritchard, Alison, Thayabaran, Darmiga, Ebmeier, Stefan, Shaw, Dominick E., Black, Peter, Braithwaite, Irene, Weatherall, Mark and Beasley, Richard (2017) Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial. npj Primary Care Respiratory Medicine, 27 (1). p. 33. ISSN 2055-1010 https://www.nature.com/articles/s41533-017-0032-z doi:10.1038/s41533-017-0032-z doi:10.1038/s41533-017-0032-z |
| spellingShingle | Pilcher, Janine Patel, Mitesh Pritchard, Alison Thayabaran, Darmiga Ebmeier, Stefan Shaw, Dominick E. Black, Peter Braithwaite, Irene Weatherall, Mark Beasley, Richard Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| title | Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| title_full | Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| title_fullStr | Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| title_full_unstemmed | Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| title_short | Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| title_sort | beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial |
| url | https://eprints.nottingham.ac.uk/43274/ https://eprints.nottingham.ac.uk/43274/ https://eprints.nottingham.ac.uk/43274/ |