PT - JOURNAL ARTICLE AU - Paul Pfeffer AU - Hajar Hajmohammadi AU - Jim Cole AU - Chris Griffiths AU - Sally Hull AU - Anna De Simoni TI - Characteristics of asthma patients overprescribed short-acting beta-agonist (SABA) reliever inhalers stratified by blood eosinophil count in North East London – a cross-sectional observational study AID - 10.3399/BJGPO.2023.0020 DP - 2023 Mar 15 TA - BJGP Open PG - BJGPO.2023.0020 4099 - http://bjgpopen.org/content/early/2023/03/15/BJGPO.2023.0020.short 4100 - http://bjgpopen.org/content/early/2023/03/15/BJGPO.2023.0020.full AB - Background Over-prescription of short-acting beta-agonist (SABA) inhalers and blood eosinophil count have strong associations with exacerbation risk in asthma. However, in our recent publication only a minority of SABA-overprescribed patients (≥6 inhalers in 12 months) were eosinophilic (≥0.3x109 cells/L).Aim To compare the characteristics of eosinophilic and non-eosinophilic SABA over-prescribed patients, and identify latent classes using clinical variables available in primary care.Design & setting Cross-sectional analysis of asthmatic patients in North East London using primary care electronic health record data.Method Unadjusted and adjusted multi-variate regression models and latent class analysis.Results Eosinophilia was significantly less likely in female patients, those with multiple mental health comorbidities and those with SABA on repeat prescription. Latent class analysis identified 3 classes of SABA over-prescribed patients representing those with classical Uncontrolled Asthma (oral-steroid requiring exacerbations, step 2–3 asthma medications, high probability of being eosinophilic), Mild Asthma (low exacerbation frequency, low asthma medication step, low probability of being eosinophilic), and Difficult Asthma (high exacerbation frequency despite high-strength preventer inhalers, low probability of being eosinophilic). The Mild Asthma class was the largest.Conclusion Many patients being over-prescribed SABA are non-eosinophilic with a low exacerbation frequency suggesting disproportionately high SABA prescription compared to other asthma control markers. Potential reasons for high SABA prescription in these patients include repeat prescription (being dispensed but not taken) and use of SABA for non-asthma breathlessness (eg, breathing pattern disorders with anxiety). Further research is needed into management of SABA overuse in patients without other markers of uncontrolled asthma.