Research Article: Prescription of oral short-acting beta 2-agonist for asthma in non-resource poor settings: A national study in Malaysia

Date Published: June 29, 2017

Publisher: Public Library of Science

Author(s): May Chien Chin, Sheamini Sivasampu, Ee Ming Khoo, Christophe Leroyer.


Use of oral short-acting beta 2-agonist (SABA) persists in non-resource poor countries despite concerns for its lower efficacy and safety. Utilisation and reasons for such use is needed to support the effort to discourage the use of oral SABA in asthma. This study examined the frequency of oral short-acting Beta 2-agonist (SABA) usage in the management of asthma in primary care and determined correlates of its usage.

Data used were from the 2014 National Medical Care Survey in Malaysia, a nationally representative survey of primary care encounters (weighted n = 325818). Using methods of analysis of data for complex surveys, we determined the frequency of asthma diagnosis in primary care and the rate of asthma medication prescription, which includes oral SABA. Multivariate logistic regression models were built to assess associations with the prescription of oral SABA.

A weighted estimate of 9241 encounters presented to primary care with asthma in 2014. The mean age of the patients was 39.1 years. The rate of oral SABA, oral steroids, inhaled SABA and inhaled corticosteroids prescriptions were 33, 33, 50 and 23 per 100 asthma encounters, respectively. It was most commonly used in patients with the age ranged between 20 to less than 40 years. Logistic regression models showed that there was a higher odds of oral SABA usage in the presence of respiratory infection, prescription of oral corticosteroids and in the private sector.

Oral SABA use in asthma is found to be common in a non- resource poor setting and its use could be attributed to a preference for oral medicines along undesirable clinical practices within a fragmented health system.

Partial Text

Asthma affects an estimated 300 million people worldwide [1] and was ranked the 15th most important disorder in the world in terms of extent and duration of disability [2]. Effective disease management remains pivotal for disease control. Principle management of asthma is well established and numerous clinical practice guidelines recommend the use of inhaled short-acting beta-agonist (SABA) as a reliever for acute asthma symptoms and early initiation of low dose inhaled corticosteroid (ICS) [1, 3–6]. The usage of oral SABA, on the other hand, has been discouraged by various asthma guidelines as a result of its safety and efficacy concerns [1, 3–6]. Numerous clinical trials have shown that oral SABA requires higher doses to produce similar efficacy as the inhaled form, leading to more adverse effects such as tachycardia, hyperactivity, decreased oxygen saturation and tremors [7–9].

About 32.6 per 100 asthma encounters in primary care prescribed oral SABA for asthma management. Its use was found to be higher among encounters with concomitant respiratory infections, with concomitant prescription of oral corticosteroids and in the private sector.

The use of oral SABA in asthma management in primary care in a non- resource poor setting is found to be common and was associated with undesirable clinical practices against a background of incoordination within a fragmented health system. Effective allocation of resources and transformation of the current clinical practices and health service delivery to promote the use of inhaled medications especially ICS are necessary and the use of oral SABA be discouraged.




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