scholarly journals The prevalence and outcome of short-acting β2-agonists overuse in asthma patients in Taiwan

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Cheng-Yi Wang ◽  
Chih-Cheng Lai ◽  
Ya-Hui Wang ◽  
Hao-Chien Wang
Keyword(s):  
Acute Exacerbation ◽  
Pay For Performance ◽  
Inhaled Corticosteroids ◽  
Severe Exacerbation ◽  
Short Acting ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Asthma Patients ◽  
Β2 Agonist ◽  
Β2 Agonists

AbstractThis study aims to investigate the prevalence of short-acting β2-agonist (SABA) overuse in asthma and the associated risk of acute exacerbation and mortality in Taiwan. We used the Taiwanese pay-for-performance asthma program database, which included patients aged between 12 and 100 years who were enrolled in the program between 2001 and 2015. Among a total of 218,039 patients, 34,641 (15.9%) patients are classified as SABA over-users. Compared with patients who did not receive inhaled corticosteroids (ICS) and collected ≤2 canisters, SABA over-users had a higher risk of severe exacerbations. SABA over-users had a higher risk of all-cause mortality compared with patients who did not receive ICS and collected ≤2 canisters. The overall prevalence of SABA overuse in Taiwan is 15.9%, and this is even higher in concomitant ICS users. In addition, the overuse of SABA is associated with an increased risk of severe exacerbation and death.

scholarly journals Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme

2020 ◽  
Vol 55 (4) ◽  
pp. 1901872 ◽  
Author(s):  
Bright I. Nwaru ◽  
Magnus Ekström ◽  
Pål Hasvold ◽  
Fredrik Wiklund ◽  
Gunilla Telg ◽  
...  
Keyword(s):  
Cox Regression ◽  
Asthma Management ◽  
Baseline Period ◽  
Population Based ◽  
Short Acting ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
Asthma Patients ◽  
Β2 Agonists

BackgroundOveruse of short-acting β2-agonists (SABA) may indicate poor asthma control and adverse health outcomes. Contemporary population-based data on use, risk factors and impact of SABA (over)use on asthma exacerbations and mortality are scarce, prompting initiation of the global SABINA (SABA use IN Asthma) programme.MethodsBy linking data from Swedish national registries, asthma patients aged 12–45 years with two or more collections of drugs for obstructive lung disease during 2006–2014 were included. SABA overuse was defined as collection of more than two SABA canisters in a 1-year baseline period following inclusion. SABA use was grouped into 3–5, 6–10 and ≥11 canisters per baseline-year. Cox regression was used to examine associations between SABA use and exacerbation (hospitalisations and/or oral corticosteroid claims) and mortality.ResultsThe analysis included 365 324 asthma patients (mean age 27.6 years; 55% female); average follow-up was 85.4 months. 30% overused SABA, with 21% collecting 3–5 canisters per year, 7% collecting 6–10 canisters per year and 2% collecting ≥11 canisters per year. Increasing number of collected SABA canisters was associated with increased risk of exacerbation, as follows. 3–5 canisters: hazard ratio (HR) 1.26 (95% CI 1.24–1.28); 6–10 canisters: 1.44 (1.41–1.46); and ≥11 canisters: 1.77 (1.72–1.83), compared to two or fewer canisters per year. Higher SABA use was associated with incrementally increased mortality risk (2564 deaths observed), as follows. 3–5 canisters: HR 1.26 (95% CI 1.14–1.39); 6–10 canisters 1.67 (1.49–1.87); and ≥11 canisters: 2.35 (2.02–2.72) compared to two or fewer canisters per year.ConclusionOne-third of asthma patients in Sweden collected three or more SABA canisters annually. SABA overuse was associated with increased risks of exacerbation and mortality. These findings emphasise that monitoring of SABA usage should be key in improving asthma management.

scholarly journals Typical Antipsychotics Increase Risk of Severe Exacerbation in Asthma Patients– A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Chin-Wei Kuo ◽  
Szu-Chun Yang ◽  
Yu-Fen Shih ◽  
Xin-Min Liao ◽  
Sheng-Hsiang Lin
Keyword(s):  
Severe Asthma ◽  
Asthma Exacerbation ◽  
High Dose ◽  
Severe Exacerbation ◽  
Severe Asthma Exacerbation ◽  
Increased Risk ◽  
Asthma Patients ◽  
Ed Visits ◽  
Dose Dependent ◽  
Typical Antipsychotics

Abstract Background:Severe asthma exacerbation reduces patients’ life quality, results in visits to the emergency department (ED) and hospitalization, and incurs additional medical costs. Antipsychotics block receptors with bronchodilation function; however, the effects of antipsychotics use on severe asthma exacerbation are unknown. This study aimed to investigate the effects of antipsychotics on asthma-related ED visits and hospitalizations.Methods:This study used a case-crossover design. Using the 2003-2017 Taiwan National Health Insurance Reimbursement Database, we established a cohort of 18,657 adults with severe asthma exacerbation leading to ED visits or hospitalization. Univariate and multivariate conditional logistic regressions were conducted to explore the association of antipsychotics use with severe asthma exacerbation. Subgroup analyses of different classes, doses, receptor functions of antipsychotics and schizophrenia were also performed.Results:Antipsychotics use was associated with a higher risk of severe asthma exacerbation (adjusted odds ratio (OR): 1.27; 95% confidence interval (CI): 1.05-1.54; P = 0.013) compared with no use of antipsychotics. Use of typical antipsychotics increased the risk of severe asthma exacerbation (adjusted OR: 1.40, 95% CI: 1.10-1.79, P = 0.007), whereas use of atypical antipsychotics did not. There was a dose-dependent effect of antipsychotics (test for trend: P =0.025). Antipsychotics that block the M2 muscarinic or D2 dopaminergic receptor were associated with an increased risk of severe asthma exacerbation (adjusted OR: 1.39, 95% CI: 1.10-1.76, P = 0.007 and adjusted OR: 1.33, 95% CI: 1.08-1.63, P = 0.008, respectively).Conclusions: Use of typical antipsychotics is associated with a dose-dependent increased risk of severe asthma exacerbation. Physicians should thus weight the risk and benefit of prescribing high-dose typical antipsychotics for asthma patients.

scholarly journals Comparative risks of chronic inhaled corticosteroids and macrolides for bronchiectasis

2019 ◽  
Vol 54 (1) ◽  
pp. 1801896 ◽  
Author(s):  
Emily Henkle ◽  
Jeffrey R. Curtis ◽  
Lang Chen ◽  
Benjamin Chan ◽  
Timothy R. Aksamit ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Respiratory Infection ◽  
Cox Regression ◽  
Inhaled Corticosteroids ◽  
Respiratory Infections ◽  
Airway Disease ◽  
International Classification Of Diseases ◽  
Increased Risk ◽  
Chronic Airway Disease ◽  
Mean Differences

IntroductionNon-cystic fibrosis (CF) bronchiectasis (“bronchiectasis”) is a chronic airway disease for which little data exist to inform treatment decisions. We sought to compare the risks of respiratory infections in chronic users of inhaled corticosteroids (ICSs) versus macrolide monotherapy.MethodsWe identified a cohort of US Medicare enrollees with a bronchiectasis diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification code 494.0 or 494.1) between 2006 and 2014, excluding CF. We defined chronic new use as the first ≥28-day prescription of ICS therapy or macrolide monotherapy. We compared the characteristics of the exposure cohorts using standardised mean differences (SMDs) and computed a propensity score (PS) to account for treatment differences. The risks of acute exacerbation, hospitalised respiratory infection, all-cause hospitalisation and mortality were compared using PS decile-adjusted Cox regression models.ResultsWe identified 83 589 new users of ICSs and 6500 new users of macrolides from 285 043 included Medicare enrollees with bronchiectasis. The crude incidence of hospitalised respiratory infection was 12.6 (ICS therapy) and 10.3 (macrolide monotherapy) per 100 patient-years. The PS-adjusted HRs comparing ICS with macrolide new users were 1.39 (95% CI 1.23–1.57) for hospitalised respiratory infection, 1.56 (95% 1.49–1.64) for acute exacerbation and 1.09 (95% 0.95–1.25) for mortality.InterpretationAmong patients with bronchiectasis, the use of ICSs was associated with an increased risk of hospitalised respiratory infections compared with macrolide monotherapy.

scholarly journals INCIDENCE OF HYPERTENSION IN ASTHMA PATIENTS WHO TREATED WITH BETA-2 AGONISTS BRONCHODILATORS

2017 ◽  
Vol 9 (4) ◽  
pp. 181
Author(s):  
Aprilita Rina Yanti Eff
Keyword(s):  
Medical Record Data ◽  
Cross Sectional ◽  
Duration Of Therapy ◽  
Record Data ◽  
Asthma Patients ◽  
Study Population ◽  
Retrospective Study Design ◽  
Beta 2 ◽  
Β2 Agonist ◽  
Β2 Agonists

Objective: To determine the prevalence of hypertension in hospitalized patients with asthma who were treated with beta-2 agonists. To evaluate the correlation between the duration of the use of beta-2 agonist with the incidence of hypertension.Methods: This research is a descriptive epidemiological, observational cross-sectional and retrospective study design. The study population was all adult asthma patients (age ≥ 25) without a concomitant diseases such as hypertension or metabolic syndrome treated with β2 agonists as a bronchodilator and underwent hospitalized in January 2015-December 2015 (n=108). Patient data were collected from the medical record. Data were analyzed using univariate and bivariate to count the number of occurrences of hypertension and recognizing the correlation between the duration of the use of β2 agonists with hypertension event.Results: The incidence of hypertension in patients with asthma who were treated with beta-2 agonists are 50, 93% at the stage of pre-hypertension (120 mm Hg/80 mm Hg) and 25, 9% in stage I hypertension (140 mmHg/90 mmHg). Body weight and duration of therapy with a β2 agonist positively correlated with the incidence of hypertension with a correlation coefficient (r) 0.231 and 0.386 respectively.Conclusion: In this study, duration of therapy with a β2 agonist in asthma patients positively correlated with the incidence of hypertension. 

scholarly journals Peculiarities of Mild Asthma in Russia: the Results of SYGMA2 Study

2021 ◽  
Vol 93 (4) ◽  
pp. 449-455
Author(s):  
Zaurbek R. Aisanov ◽  
Sergey N. Avdeev ◽  
Vladimir V. Arkhipov ◽  
Andrey S. Belevsky ◽  
Nikolay A. Voznesenskiy
Keyword(s):  
Smoking Status ◽  
Descriptive Analysis ◽  
Symptom Control ◽  
Mild Asthma ◽  
Severe Exacerbation ◽  
Open Label ◽  
Double Blind ◽  
Short Acting ◽  
Increase Risk ◽  
Asthma Patients

Aim. Patients with mild asthma may experience severe exacerbations. This analysis was conducted to investigate regional peculiarities of mild asthma population in Russia. Materials and methods. The SYGMA2 is a double-blind multinational study involving adult patients with mild asthma (n=4176). We conducted an open-label descriptive analysis of the baseline characteristics of the Russian group (n=579) of SYGMA2 trial comparing to SYGMA2 population from other countries. The subanalysis was descriptive only, and no hypothesis were tested. Results. The Russian population of patients with mild asthma was comparable to the rest of countries in terms of demographic characteristics, smoking status and duration of asthma. The spirometric parameters in the Russian group was slightly worse than in the other population. At the study entry 48% of Russian patients had symptom control on maintenance therapy, but 52% were uncontrolled on short-acting bronchodilators. While in other countries this ratio was inverse (55/45%). More patients with mild asthma in the Russian group had at least one severe exacerbation in the previous year (30.1% vs 20.7% in other countries). Conclusion. We revealed a delayed prescription of controller therapy and overuse of short-acting bronchodilators in the Russian group of mild asthma patients, that may increase risk of asthma non-control and severe exacerbation.

scholarly journals Evaluation of treatment of the exacerbation of asthma and wheezing in a pediatric emergency department

2020 ◽  
Vol 66 (9) ◽  
pp. 1270-1276
Author(s):  
Francisco de Assis Pereira Filho ◽  
Roseli Oselka Saccardo Sarni ◽  
Neusa Falbo Wandalsen
Keyword(s):  
Pediatric Emergency ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Short Acting ◽  
Drug Of Choice ◽  
Increased Risk ◽  
Level Of Use ◽  
Risk Of Treatment ◽  
Β2 Agonist ◽  
Wide Dissemination

SUMMARY OBJECTIVES: To evaluate the treatment of wheezing and exacerbation of asthma in a pediatric emergency unit (ED), comparing it to that recommended by the guidelines for this purpose. METHODS: Descriptive cross-sectional study through medical records survey of children and adolescents (0–15 years of age) who received medication for wheezing or asthma exacerbation from January to April 2015 in the ED. The selected treatment was compared to that recommended by the guidelines, being analyzed the variables related to the medication (number and dose of short-acting β2 agonist, associated or not with anticholinergic, oral or parenteral corticosteroid) and the length of stay in ED (≤1 h, ≥8 h and hospital admission). RESULTS: One-thousand eleven patients were selected with 56.7% between 3 and 15 years and 56% male. Although the selected drugs were in accordance with what was recommended, errors were observed in relation to dose, drug of choice, and method and time of use with the most frequent finding being incorrect dose (short-acting β2 agonist: 66% and ipratropium bromide: 95.2%). CONCLUSION: The level of use of the measures recommended by the guidelines was low but compatible with other studies, leading to an increased risk of treatment failure and higher costs. Despite wide dissemination, the established concepts have not been sufficiently incorporated into clinical practice, suggesting the need for more effective educational actions for this process to occur.

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