Abstract Rationale Regular short-acting β2-agonist (SABA) use leads to β2-receptor downregulation, reduced bronchoprotection, rebound hyper-responsiveness, and increased eosinophilic inflammation. Excessive SABA use correlates with higher risks of asthma exacerbations, hospitalizations, and mortality. Consequently, SABA monotherapy is no longer the preferred reliever per current guidelines. In this health system-wide quality improvement (QI) initiative, we analyzed SABA refill prescription patterns among specialist-treated asthma patients (Allergy-Immunology, Adult and Pediatric Pulmonology) before and after a direct campaign to reduce SABA prescribing practices. Data from primary care asthma patients were included for comparison. Methods Electronic Health Record (EHR) data were extracted to create a project dashboard. Analyses included asthma patients aged ≥12 years, seen at least twice within two years, categorized by specialty. Baseline “canister count” represented the total of prescribed inhalers plus available refills. Patients were categorized by annual canister counts with ≥3 canisters/year identified as the threshold for potential harm. We also assessed trends in new albuterol prescriptions, and prescriptions allowing 3 canisters/year. SABA prescribing practices were compared by specialty before and after provider/clinic education campaigns, focused patient instruction tools for AIR (Anti-inflammatory Relievers), and EHR-based best practice alerts and Smart Order Sets. Results In September 2023, 1,949 specialist-treated asthma patients were analyzed. Overall, 81% received ≥3 SABA canisters/year—70% in Allergy-Immunology, 90% in Adult Pulmonology, and 97% in Pediatric Pulmonology. A provider survey (n = 92) revealed limited awareness of the specific ≥3 canister/year harm threshold, though most respondents recognized general SABA-related harm and benefits of steroid-based relievers. Following interventions, Adult and Pediatric Pulmonary services demonstrated improvement in prescribing patterns, with Adult Pulmonary showing a marked reduction in SABA prescriptions—lower than rates observed in Primary Care. The increase in Allergy is being evaluated but felt related to updates needed in nursing protocols for example. Trends indicated an overall decrease in high (≥3 canister/year) SABA refill rates, suggesting increasing impact of the initiative over time (Table 1). Conclusion A coordinated, health system-supported QI initiative can reduce excessive SABA prescribing. However, the magnitude of improvement varies by subspecialty and patient population. Tailored interventions and sustained data feedback are critical to optimizing reliever therapy in alignment with GINA recommendations. Disseminating and adapting such strategies across systems may further advance rational SABA use and improve asthma outcomes. This abstract is funded by: Department of Internal Medicine Quality Improvement (QI) Faculty Award
Mohan et al. (2026) studied this question.