Is albuterol overuse a marker of psychological distress?

Published Online: September 1, 2015

Using too much albuterol, a medication that quickly relieves asthma symptoms, can be harmful. Based on prescription refills, patients who use three or more canisters of albuterol a year have approximately twice the risk of emergency department visits and hospitalizations than patients who use less. A better understanding of how patients use their albuterol and what factors are associated with overuse is needed.

This study, reported in The Journal of Allergy and Clinical Immunology: In Practice, investigated how 416 adult patients with mild asthma took their albuterol on days with and without symptoms. Dr. Joe Gerald at The University of Arizona used data from the American Lung Association-Asthma Clinical Research Centers’ Trial of Asthma Patient Education (TAPE). As part of this study, patients kept a daily dairy for four weeks in which they recorded medication use and symptoms. Upon enrollment, patients also answered questions about their asthma control, asthma knowledge, and quality-of-life including depression. Based on their diary data, patients were categorized as expected-users or over-users of albuterol. Patients were categorized as over-users if they used albuterol on most days with and without symptoms. The data were then examined for differences between expected-users and over-users.

Approximately 25% of patients were over-users of albuterol, using the equivalent of 4 canisters per year on average. While all users had similar demographic characteristics and adherence to daily controller medication, over-users had 4 more symptom days per month, used 1 more puffs of albuterol on symptom days, and used 2 more puffs on symptom free days than expected-users. Surprisingly, more than one-half of all albuterol overuse was attributable to use on symptom-free days. Over-users also reported lower asthma-related quality-of-life and were more likely to report depression symptoms than expected users.

Overuse of albuterol was common among the adult patients with mild asthma enrolled in this study. Over-users reported more symptoms, lower asthma-related quality-of-life, and more depression symptoms than expected users. Using albuterol on days without symptoms was an unexpectedly important source of overuse. While many factors may lead patients to overuse albuterol, future study is needed to determine whether recognizing and treating symptoms of depression could improve asthma control and reduce albuterol use.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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