Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort

Ganse, Éric Van; Texier, Nathalie; Dima, Alexandra; Belhassen, Manon; Laforest, Laurent; Herbage, Sandrine; Schück, Stéphane; Hernández, Gimena; Garín, Olatz; Ferrer, Montse; Bruin, Marijn de

doi:10.1016/j.anai.2019.12.012

Cited by 13 publications

(13 citation statements)

References 24 publications

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“…In line with our study, an association between SABA use and exacerbations has been found in several studies 26 , 27 . More conflicting evidence has been found about the association between ICS adherence and exacerbations.…”

Section: Discussionsupporting

confidence: 93%

Understanding relationships between asthma medication use and outcomes in a SABINA primary care database study

Vervloet

Dijk

Weesie

et al. 2022

npj Prim. Care Respir. Med.

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Adherence to inhaled corticosteroids (ICS) in asthma is suboptimal. Patients may rely more on their short-acting beta-agonist (SABA) to control symptoms, which may increase their risk of exacerbations and uncontrolled asthma. Our objective is to describe ICS adherence and SABA use among Dutch primary care patients with asthma, and how these are related to exacerbations and self-reported asthma control. Patients aged ≥12 years diagnosed with asthma who received ≥2 inhalation medication prescriptions in 2016 were selected from the Nivel Primary Care Database. ICS adherence (continuous measure of medication availability), SABA use (number of prescriptions), exacerbations (short courses of oral corticosteroids with daily dose ≥20 mg), and asthma control (self-reported with the Asthma Control Questionnaire; ACQ) were computed. Multilevel logistic regression analyses, to account for clustering of patients within practices, were used to model associations between ICS adherence, SABA use, and asthma outcomes. Prescription data of 13,756 patients were included. ICS adherence averaged 62% (SD: 32.7), 14% of patients received ≥3 SABA prescriptions, and 13% of patients experienced ≥1 exacerbation. Self-reported asthma control was available for 2183 patients of whom 51% reported controlled asthma (ACQ-5 score <0.75). A higher number of SABA prescriptions was associated with a higher risk of exacerbations and uncontrolled asthma, even with high ICS adherence (>90%). ICS adherence was not associated with exacerbations, whilst poor ICS adherence (≤50%) was associated with uncontrolled asthma. In conclusion, increased SABA use is an important and easily identifiable signal for general practitioners to discuss asthma self-management behavior with their patients.

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Section: Discussionsupporting

confidence: 93%

Understanding relationships between asthma medication use and outcomes in a SABINA primary care database study

Vervloet

Dijk

Weesie

et al. 2022

npj Prim. Care Respir. Med.

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“…The SABA use IN Asthma (SABINA) program in adults and adolescents with asthma reported that SABA overuse (≥3 canisters/year) is prevalent in Sweden 17 and associated with poor asthma‐related outcomes 18,19 . Few studies have evaluated SABA use in the pediatric population or its impact on clinical outcomes 20–25 . Examining the extent of SABA collection and associated clinical outcomes in children across age groups and asthma phenotypes may provide further insights into reducing asthma morbidity in children.…”

Section: Introductionmentioning

confidence: 99%

Short‐acting β₂‐agonist use and asthma exacerbations in Swedish children: A SABINA Junior study

Nwaru

Wiklund

Licht

et al. 2022

Pediatric Allergy Immunology

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Background: In adults and adolescents with asthma, use of ≥3 short-acting β 2 -agonist (SABA) canisters/year is associated with increased exacerbation risk. Whether this association is present in younger children remains unknown. In this SABA use IN Asthma (SABINA) Junior study, we assessed the association of SABA collection with exacerbation risk in the general Swedish pediatric asthma population. Methods: This population-based cohort study utilized linked data from the Swedish national healthcare registries involving patients with asthma (<18 years) treated in secondary care between 2006-2015. Exacerbation risk, by baseline SABA collection (0-2 vs. ≥3 canisters, further examined as ordinal/continuous variable) and stratified on comorbid atopic disease (allergic rhinitis, dermatitis and eczema, and food/other allergies), was assessed for 1-year follow-up using negative binomial regression. Results: Of 219,561 patients assessed, 45.4%, 31.7%, and 26.5% of patients aged 0-5, 6-11, and 12-17 years, respectively, collected ≥3 SABA canisters during the baseline year (high use). Collection of ≥3 SABA canisters (vs. 0-2) was associated with increased exacerbation risk during follow-up (incidence rate ratios [95% confidence

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“… 17 The difference between LABAs and ICS coverage rates has been identified previously, representing a risky situation, with some patients using LABAs as monotherapy, without the simultaneous use of ICS. 16 , 18 Of importance, this prescribing pattern has now virtually disappeared. 19 …”

Section: Discussionmentioning

confidence: 99%

Treatment of Allergic Rhinitis and Asthma in Primary Care: Dispensations Do Not Align with Prescriptions

Belhassen¹,

Bérard²,

Devouassoux³

et al. 2022

JAA

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Background Appropriate use of effective treatments is required for satisfactory control of allergic symptoms. Coherent medical care -regular prescribing by the same Health Care Professionals- is a preliminary need. Objective We investigated the numbers of distinct prescribers, the regularity of medical visits, and the agreement between prescriptions and associated dispensations in individual patients with perennial allergic rhinitis (PAR) and asthma. Methods In primary care electronic health records (EHRs), a cohort of patients with PAR and asthma was identified. Individual EHRs were linked to corresponding claims recording all dispensations. Prescribing patterns were analyzed for the major treatment classes, and the dispensations linked to individual prescriptions were retrieved to compute the proportions of days covered (PDCs) for asthma and PAR therapy. Results A total of 3654 patients were included, with 62% being female (mean age, 46.1 years). At inclusion, asthma control was not optimal in 51% of the patients and 48% had received oral corticosteroids. The mean interval between successive prescriptions varied between 93 (leukotriene receptor antagonists, LTRAs) and 103 (inhaled corticosteroids, ICS) days, and 97 (antihistamines, AHs) and 103 days (nasal corticosteroids, NCS). On average, individual prescriptions lead to 1.2, 1.5, 1.7 and 1.8 dispensations of ICS, ICS/Long-Acting Beta-Agonist (LABA) fixed-dose combinations, LABAs, and LTRAs, respectively, and to 1.3 and 1.6 dispensations of NCS and AHs, respectively. PDCs then varied between 37.8% for ICS and 58.6% for LTRAs, and between 39.7% for NCS and 50.4% for AHs. Care was nonetheless coherent, with >90% of all dispensations related to prescriptions issued by single General Practitioners (GPs). Conclusion Despite regular healthcare visits and medication prescriptions, allergic patients only partly and selectively refilled their treatments, preferring the less effective therapy, in a context of poor control of asthma symptoms.

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Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort

Cited by 13 publications

References 24 publications

Understanding relationships between asthma medication use and outcomes in a SABINA primary care database study

Understanding relationships between asthma medication use and outcomes in a SABINA primary care database study

Short‐acting β₂‐agonist use and asthma exacerbations in Swedish children: A SABINA Junior study

Treatment of Allergic Rhinitis and Asthma in Primary Care: Dispensations Do Not Align with Prescriptions

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Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort

Cited by 13 publications

References 24 publications

Understanding relationships between asthma medication use and outcomes in a SABINA primary care database study

Understanding relationships between asthma medication use and outcomes in a SABINA primary care database study

Short‐acting β2‐agonist use and asthma exacerbations in Swedish children: A SABINA Junior study

Treatment of Allergic Rhinitis and Asthma in Primary Care: Dispensations Do Not Align with Prescriptions

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Short‐acting β₂‐agonist use and asthma exacerbations in Swedish children: A SABINA Junior study