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"Tossing a coin:" defining the excessive use of short-acting beta2-agonists in asthma-the views of general practitioners and asthma experts in primary and secondary care.

ABSTRACT: The National Review of Asthma Deaths (NRAD) identified high prescribing of short-acting beta2-agonists (SABAs) as a key factor in over 40% of deaths. We interviewed asthma experts from both a hospital background (n?=?5) and a primary care background (n?=?8), and general practitioners delivering asthma care (n?=?8), to identify how SABA use is defined and perceived. We identified disparity in how acceptable SABA use is defined, ranging from 0.5 (100 doses/year) to 12 SABA inhalers (2400 doses/year), and complacency in the perception that over-use did not represent a marker for risk of asthma death. Despite current evidence, these findings suggest clinicians of various backgrounds are complacent about excessive SABA use.

SUBMITTER: McKibben S

PROVIDER: S-EPMC6052065 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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"Tossing a coin:" defining the excessive use of short-acting beta<sub>2</sub>-agonists in asthma-the views of general practitioners and asthma experts in primary and secondary care.

McKibben Shauna S Bush Andy A Thomas Mike M Griffiths Chris C

NPJ primary care respiratory medicine 20180718 1

The National Review of Asthma Deaths (NRAD) identified high prescribing of short-acting beta<sub>2</sub>-agonists (SABAs) as a key factor in over 40% of deaths. We interviewed asthma experts from both a hospital background (n = 5) and a primary care background (n = 8), and general practitioners delivering asthma care (n = 8), to identify how SABA use is defined and perceived. We identified disparity in how acceptable SABA use is defined, ranging from 0.5 (100 doses/year) to 12 SABA inhalers (240 ...[more]

PMID: 30022059

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Project description:1 The principal aim of the present study was to determine whether long-term treatment of human lung mast cells (HLMC) with the clinically-relevant beta(2)-adrenoceptor agonists, salbutamol and terbutaline, leads to desensitization of beta(2)-adrenoceptor-mediated responses in these cells. 2 The non-selective beta-adrenoceptor agonist, isoprenaline, and the selective beta(2)-adrenoceptor agonists, salbutamol and terbutaline, inhibited the IgE-mediated release of histamine from HLMC. Salbutamol (pD(2); 7.7+/-0.3) and terbutaline (pD(2); 7.3+/-0.2) were roughly equipotent as inhibitors of histamine release although both agonists were less potent than isoprenaline (pD(2); 8.6+/-0.2). 3 Isoprenaline (10(-5) M), salbutamol (10(-5) M) and terbutaline (10(-5) M) enhanced total cell cAMP levels in HLMC over basal by 361+/-90, 150+/-38 and 165+/-35%, respectively. 4 Long-term exposure (24 h) of HLMC to either salbutamol (10(-7) M) or terbutaline (10(-7) M) led to a subsequent reduction in the effectiveness of salbutamol and terbutaline (both 10(-9)-10(-4) M) to inhibit histamine release. However, salbutamol was significantly (P<0.05) more effective than terbutaline at promoting the functional desensitization. 5 Radioligand binding studies, using iodinated cyanopindolol, were performed to determine beta(2)-adrenoceptor density in cell membranes after pretreatment (24 h) of cells with either salbutamol (10(-6) M) or terbutaline (10(-6) M). Both agonists reduced beta(2)-adrenoceptor density in membranes to about the same extent (approximately 25% reduction) but these changes in receptor density were not statistically significant (P>0.05). 6 These data indicate that long-term exposure of mast cells to salbutamol causes greater levels of desensitization to beta(2)-adrenoceptor-mediated responses in HLMC than terbutaline. These findings may have wider clinical significance in the context of asthma treatment as compromised mast cell inhibition could result following long-term exposure of mast cells to short-acting bronchodilators.

Dataset Information

"Tossing a coin:" defining the excessive use of short-acting beta2-agonists in asthma-the views of general practitioners and asthma experts in primary and secondary care.

Publications

"Tossing a coin:" defining the excessive use of short-acting beta<sub>2</sub>-agonists in asthma-the views of general practitioners and asthma experts in primary and secondary care.

Similar Datasets

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