The blue puffer – known as a reliever – should only be used when a person with asthma is wheezing and feeling tight. But many use it too often making things worse.

Asthma is common in Australia, affecting one in 10 children and adults. It’s an inflammatory disease that causes the airway linings to swell when presented with certain stimuli – things like smoke, allergens, dust and chemicals. That swelling narrows the airways making it difficult to breathe, and causing the classic wheezing and coughing of asthma.

People who have asthma generally have two tiers of treatment, the first being a preventative treatment taken daily to reduce their sensitivity to those asthma triggers and control the inflammation.

The second is the puffer or inhaler you would have seen people use, or indeed used yourself – to deliver a medication that quickly opens up the airways, to deal with an asthma flare-up. The blue puffer can be life-saving, but its overuse can also be harmful, as recent Australian research has shown.

In the study, the researchers wanted to learn more about the overuse of puffers. They’re available over the counter, and while short-term use to relieve asthma symptoms is recommended, its overuse – more than a few times a week – can cause side effects like shaking, trembling and a rapid heart rate. It’s also a sign that the person’s asthma isn’t being managed in the right way, which could lead to lower quality of life and more debilitating symptoms. The researchers collected data from people purchasing puffers over the counter at pharmacies in New South Wales between 2017 and 2018. That included information about their puffer use, symptoms, whether they’d had an asthma diagnosis, and any side effects they’d experienced. More than 400 people were included in the study.

The researchers found that almost two thirds of people were overusing their puffer – using it more than three times a week. Most of them didn’t use preventative medication daily, and about half of those surveyed said that they didn’t even think that preventer medication worked – which the researchers were particularly worried about.

About a fifth of people buying a puffer didn’t have a formal diagnosis of asthma from a doctor. And those who overused their puffer were more likely to have visited their doctor about their asthma in the past year.

Implications

Asthma has significant costs to the health system and to people’s quality of life, and the authors of this study say there is a ‘hidden population’ of people who have asthma that isn’t being effectively treated – because they’re using their puffer too much and not using preventative medication enough.

If you have asthma, it’s important that it’s managed by a doctor – and that the puffer isn’t used too much. It can delude you into thinking your asthma is okay while underneath it’s getting worse and making you more vulnerable to a life threatening attack.

Last Reviewed: 20/07/2020

© Norman Swan Medical Communications.



References

For reference: Azzi, et al (2019). Understanding reliever overuse in patients purchasing over-the-counter short-acting beta2 agonists: an Australian community pharmacy-based survey. BMJ Open doi: 10.1136/bmjopen-2019-028995.

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