High SABA Use Linked to Exacerbation Risk, More Healthcare Utilisation

Sarfaroj Khan 

August 05, 2020

Takeaway

  • High short-acting β2-agonist (SABA) inhaler use (≥3 canisters/year) is seen in over one-third of UK patients with asthma.

  • High SABA use is associated with a significant increase in exacerbations and healthcare utilisation, irrespective of asthma severity.

Why this matters

  • The Global Initiative for Asthma no longer recommends treatment with as-needed SABA alone for symptom relief in adolescents and adults.

  • Findings suggest that SABA prescription practices need to be aligned with current treatment recommendations.

Study design

  • As part of the SABINA (SABA use IN Asthma) programme, this study (SABINA I) included 574,913 patients with asthma (age, ≥12 years) using data from the UK Clinical Practice Research Datalink, 2007-2017.

  • The association between SABA inhaler use by British Thoracic Society (BTS) treatment steps (grouped as BTS steps 1/2 for mild asthma and steps 3-5 for moderate-to-severe asthma) and exacerbations was evaluated.

  • Funding: AstraZeneca.

Key results

  • Overall, 218,365 (38%) patients had high SABA inhaler use; 336,412 patients with asthma had linked hospital data; 222,135 (66%) received BTS steps 1/2 treatment and 114,277 (34%) received steps 3-5 treatment.

  • High SABA vs low SABA (0-2 canisters/year) inhaler users were at a significantly increased risk of:

    • exacerbations (BTS steps 1/2: adjusted HR [aHR], 1.20; 95% CI, 1.16-1.24; BTS steps 3-5: aHR, 1.24; 95% CI, 1.20-1.28).

    • asthma-related primary care consultations (BTS steps 1/2: adjusted incidence rate ratio [aIRR], 1.24; 95% CI, 1.23-1.26; BTS steps 3-5: aIRR, 1.13; 95% CI, 1.11- 1.15).

    • hospital outpatient consultations (BTS steps 1/2: aIRR, 1.19; 95% CI, 1.12-1.27; BTS steps 3-5: aIRR, 1.19; 95% CI, 1.13-1.26).

Limitations

  • Retrospective design.

  • Overestimation of actual SABA inhaler use.

 

Bloom CI, Cabrera C, Arnetorp S, Coulton K, Nan C, van der Valk RJP, Quint JK. Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program. Adv Ther. 2020 Jul 27 [Epub ahead of print]. doi: 10.1007/s12325-020-01444-5. PMID: 32720299 View abstract. 

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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