Over-the-counter use of short-acting beta-2 agonists: a systematic review

Zhe Chi Loh; Rabia Hussain; Siew Chin Ong; Bandana Saini; Jaya Muneswarao; Anees Ur-Rehman; Zaheer-Ud-Din Babar

doi:10.1186/s40545-023-00627-z

Over-the-counter use of short-acting beta-2 agonists: a systematic review

J Pharm Policy Pract. 2023 Oct 9;16(1):119. doi: 10.1186/s40545-023-00627-z.

Authors

Zhe Chi Loh¹, Rabia Hussain², Siew Chin Ong¹, Bandana Saini³, Jaya Muneswarao⁴, Anees Ur-Rehman⁵, Zaheer-Ud-Din Babar⁶

Affiliations

¹ School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia.
² School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia. rabia.hussain2010@gmail.com.
³ Faculty of Medicine and Health, University of Sydney School of Pharmacy, The University of Sydney, Sydney, NSW, 2006, Australia.
⁴ Pharmacy Department, Hospital Pulau Pinang, 10990, George Town, Pulau Pinang, Malaysia.
⁵ Bahauddin Zakariya University, Multan, Pakistan.
⁶ Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK.

Abstract

Background: The widespread use of short-acting beta-2 agonists (SABA) as an as-needed treatment for asthma is well-established. However, excessive use of SABA has been linked to undesirable outcomes such as increased risk of asthma attacks, exacerbations, and even death. The availability of SABA as an over-the-counter (OTC) medication has contributed to their overuse, leading to undertreated asthma and reduced access to asthma education.

Objective: This systematic review aimed to summarize the prevalence, characteristic features of, and factors contributing to over-the-counter SABA purchase or overuse.

Methods: The databases searched included PubMed, Scopus, Springer Link, Google Scholar, CINAHL, and APA PsycArticles. Original research articles reporting the prevalence, characteristics features, and factors regarding over-the-counter SABA use, available as full text, published in English language between the year 2000 and April 2023 were included in this review. Commentaries, letters to editor, review articles, qualitative studies, clinical trials, and conference proceedings were excluded. Data extraction was followed by a review of the quality of studies included and data were then synthesized for meaningful findings. This systematic review had been registered in the PROSPERO with registration number CRD42023421007.

Results: A total of 18 articles were included. The prevalence range of OTC SABA users in populations were 1.4% to 39.6% and SABA over-users among OTC users were 14% to 66.4%. Factors mostly associated with this behavior were moderate-severe asthma, and less use of preventers. On top of that, not understanding the risk of SABA overuse was clear in many studies that explored this factor.

Conclusion: Over-the-counter purchase and overuse of SABA medication is a common problem, leading to adverse consequences such as uncontrolled asthma and increased healthcare utilization. Addressing these issues requires improved patient education about their conditions and adequate information regarding the potential long-term effects of SABA use by the healthcare providers. Management and education of asthma patients, including regular monitoring and follow-up, can help reduce overuse of SABA medication and prevent negative consequences.

Keywords: Characteristics features; Factors; Over-the-counter; Prevalence; SABA; Short-acting beta-2 agonists.

Publication types

Review

Grants and funding

304/PFARMASI/6315769/Universiti Sains Malaysia