Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program

Abstract

Introduction: Patients with asthma typically increase short-acting b 2-agonists (SABA) use with worsening symptoms. Excessive SABA use may lead to a higher risk of adverse outcomes. We evaluated, in a large population cohort, an association between SABA inhaler use and asthma exacerbations and healthcare utilization.

The Burden of Short-Acting β2-Agonist Use in Asthma: Is There an Italian Case? An Update from SABINA Program

“…The results from the multivariate model run on the IQVIA LPD cohort showed that patients who had more than two SABA canisters/year have a 30% higher likelihood of experiencing exacerbations when compared to patients who had no more than two SABA canisters/year. The latter result is in total agreement with results from SABINA I study performed in the UK [15], which found a 20% increased risk of exacerbations for both step 1-2 and 3-5 patients who had a high level of SABA use (i.e., more than two canisters/year) [15]. Furthermore, GINA guidelines state that dispensing more than two SABA canisters/year is associated with an increased risk of emergency department visit or hospitalization independent of severity [1].…”

“…Secondly, exacerbations are not directly recorded in the database, thus requiring us to use an algorithm to detect their occurrence. However, our results, showing a higher risk of exacerbations for patients with more than two SABA canisters/year, are in line with the literature [ 4 – 7 , 15 ], indicating the appropriateness of the rules set to detect exacerbations. Moreover, as observed previously [ 15 , 25 – 27 ], the likelihood of experiencing exacerbations was increased with number of comorbidities, older age, and female sex.…”

“…However, our results, showing a higher risk of exacerbations for patients with more than two SABA canisters/year, are in line with the literature [ 4 – 7 , 15 ], indicating the appropriateness of the rules set to detect exacerbations. Moreover, as observed previously [ 15 , 25 – 27 ], the likelihood of experiencing exacerbations was increased with number of comorbidities, older age, and female sex. Thirdly, as in any study looking at inhaled treatment utilization, we cannot be sure that treatments prescribed/dispensed were actually used by patients.…”

“…Patients were grouped on the basis of the number of SABA canisters received during the first year of follow-up, and demographic and clinical characteristics, healthcare resource utilization (HRU), and number of exacerbations were compared between patients with a maximum of two SABA canisters/year and patients with more than two SABA canisters/year by means of chi-square tests. The cutoff corresponding to two SABA canisters/year was adopted on the basis of 2018 GINA guideline recommendations [ 14 ] and in agreement with all SABINA studies [ 8 , 9 , 15 , 16 ]. Asthma treatments included are detailed in Annex III of the supplementary material.…”

High Use of SABAs is Associated with Higher Exacerbation Rate in Dutch Patients with Asthma

“…Our findings that high SABA users experienced more moderate and severe asthma exacerbations and also more often had a history of courses of antibiotics and oral steroids, are in line with findings in other studies. 6,8,[19][20][21][22][23][24] This could imply that SABA usage in the preceding week can be extrapolated to SABA use in the previous year. Hence, this shows that a clinically easy and quick way of assessing SABA use, ie by merely asking the patient about their SABA use in the preceding week, could be an indicator for the risk of future exacerbations.…”