Exploring over-the-counter SABA inhaler use in Malaysian community pharmacies: a mixed-methods study

Background Non-prescription short-acting beta-2 agonists (SABA) inhalers, used to relieve asthma symptoms, are widely available in community pharmacies. This study aimed to explore the perceptions and practices of community pharmacists towards the safe use of SABA inhalers in Malaysia.Methods A concurrent mixed-methods study was conducted from December 2022 to May 2023, involving qualitative interviews (n = 12) and quantitative online surveys (n = 312) among Malaysian community pharmacists. Qualitative data was managed through NVivo® software, and thematic analysis was performed. Descriptive data analysis, including Kruskal–Wallis and Mann–Whitney tests, and regression analysis were performed using IBM SPSS v.20 for the quantitative study. Subsequently, a comparison was made between the qualitative and quantitative data.Results Most community pharmacists commonly linked effective asthma control with fewer exacerbations (n = 12) (84.3%), and decreased usage of SABA inhalers (n = 12) (65.4%), in the qualitative and quantitative studies, respectively. According to the quantitative results, 40.7% of participants were concerned with the frequency and dosage of SABA usage by asthma patients OTC. While in the qualitative phase, community pharmacists (n = 12) emphasised proper inhalation techniques for safe and effective use of non-prescription SABA inhalers. Community pharmacists from both studies suggested that effective counselling, including allocating sufficient time for counselling sessions, could enhance the safe use of SABA inhalers. The most agreed-upon perceived barriers to safe SABA inhaler use in the quantitative results were patients’ lack of awareness of available services for asthma consultations and counselling (74.4%) and insufficient time to provide counselling services (68.9%).Conclusion Community pharmacists in Malaysia correlated good asthma control status with decreased exacerbations and SABA inhaler utilisation. Furthermore, community pharmacists were concerned about patients’ techniques, dosage, and frequency of use of SABA inhalers. However, asthma reviews, monitoring systems, and patient counselling were important suggested factors in ensuring safe and effective treatment in the community pharmacy setting.