Over-Prescription of Short-Acting β2-Agonists Remains a Serious Health Concern in Kenya: Results from the SABINA III Study
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Date
2023
Authors
Chakaya, Jeremiah
Mecha, Jared
Beekman, Maarten
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Primary Care
Abstract
Background Despite a high asthma burden in Kenya, insights into asthma management practices, including prescription of short-acting β2-agonists (SABAs), are lacking. Therefore, this study describes patient demographics,
disease characteristics, and asthma treatment patterns in the Kenyan cohort of the SABA use IN Asthma (SABINA) III
study.
Methods Patients with asthma (aged≥12 years) with medical records containing data for≥12 months prior
to the study visit from 19 sites across Kenya were included in this cross-sectional study and classifed by investigatordefned asthma severity (guided by the 2017 Global Initiative for Asthma [GINA] recommendations) and practice type
(primary/specialist care). Data on severe exacerbation history, prescribed asthma treatments, and over-the-counter
(OTC) SABA purchases in the 12 months before the study visit and asthma symptom control at the time of the study
visit were collated using electronic case report forms. All analyses were descriptive in nature.
Results Overall, 405 patients were analyzed (mean age, 44.4 years; female, 68.9%), of whom 54.8% and 45.2% were
enrolled by primary care clinicians and specialists, respectively. Most patients were classifed with mild asthma
(76.0%, GINA treatment steps 1−2) and were overweight or obese (57.0%). Only 19.5% of patients reported full
healthcare reimbursement, with 59% receiving no healthcare reimbursement. The mean asthma duration of patients
was 13.5 years. Asthma was partly controlled/uncontrolled in 78.0% of patients, with 61.5% experiencing≥1 severe
exacerbation in the preceding 12 months. Crucially, 71.9% of patients were prescribed≥3 SABA canisters, defned
as over-prescription; 34.8% were prescribed≥10 SABA canisters. Additionally, 38.8% of patients purchased SABA OTC,
of whom 66.2% purchased≥3 SABA canisters. Among patients with both SABA purchases and prescriptions, 95.5%
and 57.1% had prescriptions for≥3 and≥10 SABA canisters, respectively. Inhaled corticosteroids (ICS), ICS with a longacting β2-agonist fxed-dose combination, and oral corticosteroid bursts were prescribed to 58.8%, 24.7%, and 22.7%
of patients, respectively.
Conclusions SABA over-prescription occurred in almost three-quarters of patients, with over one-third of patients
purchasing SABA OTC. Therefore, SABA over-prescription is a major public health concern in Kenya, underscoring
an urgent need to align clinical practices with latest evidence-based recommendations.
Description
Article
Keywords
Asthma management, Over-the-counter, Prescription, SABA, Short-acting β2-agonist
Citation
Chakaya, J., Mecha, J., & Beekman, M. (2023). Over-prescription of short-acting β2-agonists remains a serious health concern in Kenya: results from the SABINA III study. BMC Primary Care, 24(1), 141.