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

Abstract

Purpose: Many patients with asthma still have insufficient disease control, despite the availability of effective treatment options. A substantial proportion of patients appear to rely more on short-acting beta 2 -agonist (SABA) rather than on anti-inflammatory maintenance treatment. The aim of this study was to describe differences in indicators of asthma symptoms and exacerbations among patients using more or less SABA than the guidelinerecommended threshold of <3 times/week. Patients and Methods: Data from Dutch respondents in the European REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey were used in this post hoc analysis. The survey included asthma patients aged 18-50 years with at least two prescriptions for their asthma in the past two years. SABA use was categorized into two groups: <3 (low-SABA users) or ≥3 (high-SABA users) times in the last week. Results: Of the 736 asthma patients, 21% did not use SABA and 19% used SABA 1 to 2 times (all low SABA users) and 60% used SABA ≥3 times (high SABA users) in the last week. The majority of high and low SABA users also reported using an ICS-containing treatment. Significant differences were found for all indicators related to exacerbations (p<0.001): high SABA users more frequently used antibiotics and oral steroids, more frequently visited the emergency departments or needed an overnight hospital stay. Indicators of asthma symptoms were not significantly different between both groups. Conclusion:The majority of a Dutch asthmatic population reported high SABA use and had frequent moderate/severe exacerbations. More effective interventions are needed to change healthcare providers' and patients' behaviours to improve care and reduce SABA (over)use.

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“…Global Initiative for Asthma (GINA) recommendations highlight the increased risk of exacerbations associated with short-acting β2-agonist overuse [11][12][13] and recommend ICS-formoterol as a maintenance and anti-inflammatory reliever treatment (MART) for best outcomes. 3 Compared with short-acting β2-agonist use, antiinflammatory reliever therapy greatly reduces the risk of severe exacerbations.…”

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“…The hypothesis of perceived asthma control fits our hypothesis that the majority will overestimate how well their asthma is controlled due to the overuse of SABA without concomitant use of maintenance ICS therapy. It is, therefore, vital that patients and clinicians work together to achieve optimal drug therapy for patients with mild asthma, as supported by current research [ 22 - 24 ].…”

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