Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations: SABINA Findings From Europe and North America

• DOI: 10.1016/j.jaip.2022.02.047
• Publication Date: 2022-03-29T06:13:21Z
• Authors: Jennifer K. Quint; Sofie Arnetorp; Janwillem W.H. Kocks; Maciej Kupczyk; Javier Nuevo; Vicente Plaza; Claudia Cabrera; Chantal Raherison...; Brandie Walker; Erika Penz; Ileen Gilbert; Njira Lucia Lugogo; Ralf J.P. van der...; Andrew Fong; Christina Qian; Caroline Fabry-Ve...; Chantal Touboul; Dorota Brzostek; Ekaterina Maslova; Filip Surmont; Helena Goike; Hitesh Gandhi; J.C. Korevaar; Joseph Tkacz; Karissa Johnston; Keith Peres da Costa; L. van Dijk; M. Vervloet; Michael Pollack; Paul Hernandez; Silvia Boarino; Stephen G. Noorduyn; Wendy Beekman-Hen...; Y.M. Weesie
• Keywords: Rate ratio; Concomitant

Expert national/global asthma management recommendations raise the issue whether a safe threshold of short-acting beta-2 agonist (SABA) use without concomitant inhaled corticosteroids (ICS) exists.To examine SABA and maintenance therapy associations with severe exacerbations across North America Europe.Observational analyses 10 SABa IN Asthma (SABINA) datasets involving 1,033,564 patients (≥12 y) from Canada, France, Netherlands, Poland, Spain, United Kingdom, States. Negative binomial models (incidence rate ratio [IRR] [95% CI adjusted for prespecified-covariates]) evaluated between exacerbations.Across severities, 40.2% were prescribed/possessed 3 or more canisters/y. Per Global Initiative (GINA) 2018 definitions, steps to 5-treated prescribed/possessing versus 1 2 SABAs experienced (IRR 1.08 1.04‒1.13], U.S. Medicare; IRR 2.11 1.96‒2.27], Poland). This association was not observed in all step 2-treated (the 1.25 0.91‒1.71]; commercial, 0.92 0.91‒0.93]; Medicare, 0.74 0.71‒0.76]). We hypothesize that this inverse attributable large patient population possessing fewer than no receiving oral corticosteroid bursts face-to-face health care provider encounters. In monotherapy-treated patients, associated emergency/outpatient visits hospitalizations 1.31 1.29‒1.34]). Most GINA study (60.6%) did have up 50% time; however, persisted 1.32 1.18‒1.49]) after excluding these independent effect further confirmed when U.K. data analyzed as continuous variable 100% annual coverage ICS-containing medications.Increasing exposure is exacerbation risk, therapy. As addressed by GINA, based on studies severities where as-needed fast-acting bronchodilators ICS decrease compared SABA, our findings highlight importance avoiding rescue/reliever paradigm utilizing monotherapy.