Over-prescription of short-acting beta agonists in the treatment of asthma

Family Practice ◽

10.1093/fampra/cmab013 ◽

2021 ◽

Author(s):

Ingrid Looijmans-van den Akker ◽

Anouk Werkhoven ◽

Theo Verheij

Keyword(s):

Asthma Control ◽

Asthma Medication ◽

Health Centers ◽

Short Acting ◽

Asthma Symptoms ◽

Beta Agonists ◽

Asthma Exacerbations ◽

Systemic Corticosteroids ◽

Clear Guideline ◽

Β2 Agonists

Abstract Background Despite a clear guideline for asthma medication, excessive use of short-acting β2-agonists (SABAs) is common in clinical practice. Previous research has shown that excessive use of SABAs is associated with poor asthma control. Objective This study examines current use of asthma medication in primary care and whether excessive use of SABAs is associated with exacerbations. Methods The study design was a retrospective analysis using information from electronical medical records from patients aged 18 and older of five Julius Health Centers located in Utrecht, the Netherlands, in the period of 1 July 2018 through 1 July 2019. Excessive SABA use was defined as ≥400 inhalations per year. An exacerbation was defined as an acute worsening of asthma symptoms with the need for systemic corticosteroids. Results A total of 1161 patients were included in the study. Of the patients using SABAs (n = 766), 193 (25%) overused SABAs. Among the patients with inappropriate SABA use (n = 193), 19% had an exacerbation compared with 7% of the appropriate SABA users. For patients using asthma medication the odds of having an exacerbation were 2.9 times higher if they used an inappropriate number of SABAs than if SABAs were used appropriately (odds ratio, 2.897; 95% confidence interval, 1.87–4.48). Conclusions This study shows that overuse of SABAs is still common and that it is associated with asthma exacerbations. It highlights that clinicians need to be aware of inappropriate SABA use as it is a sign of and can even contribute to poor asthma control.

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Role of antileukotrienes in acute asthma exacerbations

Reviews in Health Care ◽

10.7175/rhc.v3i2.155 ◽

2012 ◽

Vol 3 (2) ◽

pp. 75-81

Author(s):

Domenico Lorenzo Urso ◽

Daniele Vincenzo ◽

Lorenzo Formaro ◽

Ada Federico ◽

Giuseppe Urso

Keyword(s):

Acute Asthma ◽

Significant Proportion ◽

Rapid Onset ◽

Supplemental Oxygen ◽

Current Standard ◽

Onset Of Action ◽

Asthma Exacerbations ◽

Systemic Corticosteroids ◽

Acute Asthma Exacerbations ◽

Β2 Agonists

Acute asthma exacerbations are one of the most frequent reasons to visit the emergency department or general practitioner. Although current standard treatments for acute asthma – including supplemental oxygen, short-acting β2-agonists, systemic corticosteroids and anticholinergics – are quite effective in most patients, they are inadequate for rapid and sustained improvement in a significant proportion. The antileukotrienes, a relatively new class of drugs, have a role in the treatment of chronic asthma. Their relatively rapid onset of action after endovenous or oral administration and their additive effect to β2-agonists led to the hypothesis that they might be of benefit in acute asthma. This review examines the efficacy of antileukotrienes in the treatment of acute asthma.

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Short-acting β2-agonists (SABA) bronchodilator sales and outdoor mould in central France

Clinical and Translational Allergy ◽

10.1186/s13601-019-0296-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

D. M. Caillaud ◽

S. Martin ◽

C. Ségala ◽

N. Dupuy ◽

M. Thibaudon ◽

...

Keyword(s):

Young Adults ◽

Generalized Additive Models ◽

Weather Conditions ◽

Emergency Department Visits ◽

Additive Models ◽

Short Acting ◽

Asthma Exacerbations ◽

Children And Young Adults ◽

The Relationship ◽

Β2 Agonists

Background Temporal ecological studies have shown that outdoor moulds are associated with severe asthma exacerbations, as emergency department visits or hospitalisations. The aim of this was to assess the associations between daily sales of short-acting β2-agonists (SABA), a specific and frequent treatment for control of mild asthma exacerbations in children and young adults, and outdoor mould concentrations in the central France area over a 5 year period. Methods The relationship between daily changes in mould (25 species) concentrations and daily SABA sales within a population of patients aged 6 to 39 years in a middle-size town of central France (approximately 127,000) was obtained from social security database and analysed with generalized additive models, taking into account confounding factors (air pollution, weather conditions, pollen counts and trend). Results Daily SABA sales (mean, SD) rose from 17.3 (9.7) in 2010 to 22.7 (12) in 2015. The relative risk (RR [95% CI]) of SABA sales associated with an interquartile increase in mould concentration was significant in the whole population for Alternaria 1.06 [1.002–1.12]. When the influence of age and sex was accounted for, the relationship was significant only in 6–12 years old males for Alternaria 1.21 [1.04–1.41] and Aspergillus–Penicillium 1.08 [1.04–1.12]. Conclusions Daily SABA sales are positively associated with Alternaria spores in the general population of children and young adults. The association between daily SABA sales and temporal changes to Alternaria and Aspergillus–Penicillium in male children indicate that outdoor moulds contribute to asthma morbidity.

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Asthma Medication Regimens in Pregnancy: Longitudinal Changes in Asthma Status

American Journal of Perinatology ◽

10.1055/s-0041-1727233 ◽

2021 ◽

Author(s):

Matthew C.H. Rohn ◽

Danielle R. Stevens ◽

Jenna Kanner ◽

Carrie Nobles ◽

Zhen Chen ◽

...

Keyword(s):

Lung Function ◽

Asthma Control ◽

Propensity Scores ◽

First Trimester ◽

Forced Expiratory Volume ◽

Asthma Medication ◽

Severe Exacerbation ◽

Medication Regimen ◽

Asthma Symptoms ◽

The Impact

Objective This study aimed to assess the impact of common asthma medication regimens on asthma symptoms, exacerbations, lung function, and inflammation during pregnancy. Study Design A total of 311 women with asthma were enrolled in a prospective pregnancy cohort. Asthma medication regimen was categorized into short-acting β agonist (SABA) alone, SABA + inhaled corticosteroid (ICS), SABA + ICS + long-acting β agonist (LABA), and no asthma medications (reference). We evaluated asthma control at enrollment (< 15 weeks' gestation) and its change into trimesters 2 and 3, including per cent predicted forced expiratory volume in 1 second (%FEV1) and peak expiratory flow (%PEF), pulse oximetry, fractional exhaled nitric oxide (FeNO), asthma symptoms (asthma attacks/month, night symptoms/week), and severe exacerbations. Linear mixed models adjusted for site, age, race, annual income, gestational age, body mass index, and smoking, and propensity scores accounted for asthma control status at baseline. Results Women taking SABA + ICS and SABA + ICS + LABA had better first trimester %PEF (83.5% [75.7–91.3] and 84.6% [76.9–92.3], respectively) compared with women taking no asthma medications (72.7% [66.0–79.3]). Women taking SABA + ICS + LABA also experienced improvements in %FEV1 (+11.1%, p < 0.01) in the third trimester and FeNO in the second (−12.3 parts per billion [ppb], p < 0.01) and third (−11.0 ppb, p < 0.01) trimesters as compared with the trajectory of women taking no medications. SABA + ICS use was associated with increased odds of severe exacerbations in the first (odds ratio [OR]: 2.22 [1.10–4.46]) and second (OR: 3.15 [1.11–8.96]) trimesters, and SABA + ICS + LABA use in the second trimester (OR: 7.89 [2.75–21.47]). Women taking SABA alone were similar to those taking no medication. Conclusion Pregnant women taking SABA + ICS and SABA + ICS + LABA had better lung function in the first trimester. SABA + ICS + LABA was associated with improvements in lung function and inflammation across gestation. However, both the SABA + ICS and SABA + ICS + LABA groups had a higher risk of severe exacerbation during early to mid-pregnancy. Key Points

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Role of antileukotrienes in acute asthma exacerbations

Reviews in Health Care ◽

10.7175/rhc.1553275-81 ◽

2012 ◽

Vol 3 (2) ◽

pp. 75

Author(s):

Domenico Lorenzo Urso ◽

Daniele Vincenzo ◽

Lorenzo Formaro ◽

Ada Federico ◽

Giuseppe Urso

Keyword(s):

Acute Asthma ◽

Significant Proportion ◽

Rapid Onset ◽

Supplemental Oxygen ◽

Current Standard ◽

Onset Of Action ◽

Asthma Exacerbations ◽

Systemic Corticosteroids ◽

Acute Asthma Exacerbations ◽

Β2 Agonists

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Effective Asthma Management: Is It Time to Let the AIR out of SABA?

Journal of Clinical Medicine ◽

10.3390/jcm9040921 ◽

2020 ◽

Vol 9 (4) ◽

pp. 921

Author(s):

Alan Kaplan ◽

Patrick D. Mitchell ◽

Andrew J. Cave ◽

Remi Gagnon ◽

Vanessa Foran ◽

...

Keyword(s):

Asthma Management ◽

Beta Agonist ◽

Inhaled Corticosteroid ◽

Short Acting ◽

Asthma Symptoms ◽

Beta Agonists ◽

Global Initiative For Asthma ◽

Global Initiative ◽

Poor Outcomes ◽

Fast Acting

For years, standard asthma treatment has included short acting beta agonists (SABA), including as monotherapy in patients with mild asthma symptoms. In the Global Initiative for Asthma 2019 strategy for the management of asthma, the authors recommended a significant departure from the traditional treatments. Short acting beta agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy because of significant safety concerns and poor outcomes. Instead, the more appropriate course is the use of a combined inhaled corticosteroid–fast acting beta agonist as a reliever. This paper discusses the issues associated with the use of SABA, the reasons that patients over-use SABA, difficulties that can be expected in overcoming SABA over-reliance in patients, and our evolving understanding of the use of “anti-inflammatory relievers” in our patients with asthma.

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