Reducing Short-Acting Beta-2 Agonist (SABA) Overuse in Asthma: A Quality Improvement Project in Primary Care

IntroductionAsthma is a common chronic respiratory condition.Current national guidelines advocate for a transition from traditional short-acting beta-2 agonist (SABA)-based approaches to anti-inflammatory reliever (AIR) and maintenance and reliever therapy (MART) to patients aged 12 years and older.We identified patients whose asthma was not well controlled at our general medical centre, analysed compliance with these guidelines and introduced appropriate measures to improve service provision. MethodsThis was a two-cycle audit.The first cycle conducted in October 2024 was a retrospective analysis of current practice.After identifying gaps in compliance with national guidelines, service improvements were implemented.A second cycle was retrospectively undertaken in September 2025 to evaluate impact.Patients having been issued a SABA inhaler at least twice in the last 12 months were deemed as having potential SABA overuse and met the inclusion criteria.Outcome measures included demographics, inhaler prescription, adherence, technique check and symptom control.The gold standard for management was derived from the National Institute for Health and Care Excellence (NICE) guidelines. ResultsNinety-four patients from the estimated 7,670 practice population met the inclusion criteria for the first audit cycle.Of these, we were able to contact 72/94 (76.6%) patients.Thirty-seven (51.2%) patients reported at least one symptom of poor asthma control against recommendations and required changes to usual medication.After presenting these findings and the patients undergoing educational and practical interventions, the second cycle was conducted.Thirty-five patients met the inclusion criteria for the second audit cycle.Of these, we were able to contact 23 (65.7%) patients.Eighteen (78.2%) patients reported at least one symptom of poor asthma control.The number of patients issued two SABA inhalers in the last 12 months at the practice decreased by 62.8% from 94 to 35 patients between cycles.The number of patients reported at least one symptom of poor asthma control decreased by 51.4% from 37 to 18 between cycles.After identifying the 18 patients who reported at least one symptom of poor asthma control in the second cycle, six consented and commenced new inhaler therapy upon being contacted and offered. ConclusionsThis quality improvement project highlights the importance of identifying and addressing SABA overuse in patients with asthma, as optimally aligning therapy with national guidelines reduces the risks associated with overuse and poor asthma control.This audit further aims to raise awareness among primary care teams to promote adherence to updated pharmacological management to improve patient outcomes and reduce primary and secondary care pressures due to poor symptom control.