SABA overuse in the Portuguese prescription database

Overuse of Short-Acting Beta-Antagonist(SABA) has been associated with poor outcomes and inadequate medical care. The Portuguese Electronic Medical Prescription(PEM) records all electronic prescriptions in the country. We aim to describe SABA overuse in Portuguese patients using the PEM database. This is a retrospective population-based analysis of anonymized PEM data from a random sample of 103647 patients. We selected patients to whom SABA was prescribed at least once, between July and December 2016. We estimated the number of doses based on the prescribed medication, defining overuser as a patient who consumes more than one canister (200 doses of 100 µg) of Salbutamol or equivalent per month. Patients characterization, prescription of concomitant medication and prescriber were also analysed. SABA was prescribed and dispensed to 2644 per 100,000(10^5) Portuguese patients. From these, 49/10^5 (1.9%) were SABA overusers, consuming a mean of more than 13 SABA inhalations per day per patient. Compared to non-overusers, SABA overusers were mostly male (68.6%[95%CI 55.0-79.7] vs 49.5%[47.6-51.4]) and above 40 years of age (94.1%[84.1-98.0] vs. 40.5%[38.6-42.4]). SABA prescribers were mostly from primary care (61.0%[54.9-66.9] vs 33.0%[31.4-34.7] for overusers and non-overusers, respectively). About 27% (14/10^5) of the overusers did not use any other respiratory medication and 33.3% used antibiotics, 7.8% used systemic corticosteroids and 5.9% used both. This is the first analysis of prescription of SABA medication from the official Portuguese prescription database. SABA overuse was frequent and more ¼ did not use any additional respiratory medication. These results suggest there is a need for initiatives to reduce SABA use in Portugal.