Reducing short-acting beta-2 agonist overuse in asthma: a quality improvement project in primary care

Background National asthma guidelines (National Institute for Health and Care Excellence or British Thoracic Society/Scottish Intercollegiate Guidelines Network) have recently been updated to recommend anti-inflammatory reliever (AIR) and maintenance and reliever therapy (MART) for patients managed on short-acting beta-2 agonist (SABA) inhalers, due to evidence linking SABA overuse with poor asthma outcomes. Aim This project aimed to identify patients over-relying on SABA inhalers, assess practice compliance with national guidelines, and implement interventions to optimise management. Interventions included asthma reviews, inhaler technique assessment, and initiating AIR/MART therapy where appropriate. Method A two-cycle retrospective audit was conducted, including adult patients issued ≥2 SABA inhalers in the last 12 months. Results In the first cycle (October 2024), 94 patients were identified, of which 72 (76.6%) could be contacted and 37 (51.4%) overused their SABA inhaler ≥3 times per week. In the second cycle (September 2025), 35 patients were identified, 23 (65.7%) could be contacted and 18 (78.3%) reported SABA inhaler overuse. Between the two cycles, the number of patients identified as issued ≥2 inhalers over 12 months decreased from 94 to 35 (−62.8%), and SABA inhaler overuse (≥3 times a week) decreased from 37 to 18 (−51.4%). Conclusion This project demonstrates that identifying SABA inhaler overuse and implementing updated national guidelines can improve asthma control and prescribing in general practice. This model could be replicated across other primary care practices to improve patient outcomes and reduce healthcare system burden.