Overuse of beta-2-agonist metered dose inhalers - Tips from Other Journals

Author: Grace Brooke Huffman
Date: May 1, 1997

With the mortality rate as high as 2 percent in children and adolescents with severe asthma, it is critical to understand the factors that lead to overuse of [beta.sub.2]-agonist metered dose inhalers in this population. Several studies have suggested that chronic use of [beta.sub.2] agonists may worsen asthma, possibly by increasing bronchial reactivity or by controlling the asthma to the point where the patient or physician does not see the need for anti-inflammatory treatment. Patients who use one or two canisters of metered dose inhaler per month have been shown to have a significantly increased risk of fatal and near-fatal asthma attacks. Beausoleil and colleagues conducted a four-year study to determine the demographic and psychologic characteristics that could lead older children and adolescents to overuse [beta.sub.2]-agonist metered dose inhalers.

Children between the ages of eight and 16 years who had been admitted to a residential treatment facility for severe chronic asthma were included in the study. Patients were considered to be overusers of [beta.sub.2] agonist if their use exceeded their physician's recommendation even after they had been warned about the dangers of overuse. Of the 55 patients included, 17 were classified as overusers and 38 were classified as non-overusers. Demographic information and psychologic testing was completed for each child.

The overuse group scored significantly lower on intelligence tests than the non-overuse group. The results of psychologic tests indicated that overusers display less attention to detail, are more dominant and have less understanding of social expectations than non-overusers. The overusers tended to be nonwhite males, including a disproportionate number of Hispanic males, and more than one half were of lower socioeconomic status (defined as at or below poverty level).

The authors conclude that there may be both intellectual and personality-related reasons for overuse of [beta.sub.2]-agonist metered dose inhalers. Patients may experience immediate relief with these medications and may then feel that no other treatment is necessary. Patients with a more concrete style of thinking as found in the overuse group may also feel that they only need to use [beta.sub.2] agonists when they are having symptoms instead of on a regular basis. The authors note that physicians should be aware of these findings and be prepared to offer "patient-specific" education, instead of giving only standardized instructions on the use of [beta.sub.2]-agonist metered dose inhalers.

GRACE BROOKE HUFFMAN, M.D. Beausoleil JL, et al. [[Beta].sub.2]-Agonist metered dose inhaler overuse: psychological and demographic profiles. Pediatrics 1997;99:40-3.

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