J Mark FitzGerald1, Hamid Tavakoli2, Larry D Lynd3, Khalid Al Efraij4, Mohsen Sadatsafavi2. 1. Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada. Electronic address: mark.fitzgerald@vch.ca. 2. Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada. 3. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada; Centre for Health Evaluation and Outcomes Research, University of British Columbia, Vancouver, Canada. 4. Division of Respirology, Department of Internal Medicine, University of British Columbia, Vancouver, Canada.
Abstract
BACKGROUND: Inappropriate use of short-acting beta-agonists (SABA) has been associated with increased morbidity and mortality in asthma. However, the extent and pattern of SABA use have changed significantly over recent years. The outcomes in patients who are contemporarily receiving inappropriate doses of SABA have not been evaluated. METHODS: We used population-based administrative health data from British Columbia (BC), Canada, to create a cohort of asthma patients aged 14 to 55. The exposure of interest was inappropriate use of SABA with any given 12-month period, as defined and validated previously. The primary outcome was asthma-related hospitalization in the following three-month period; secondary outcomes were asthma-related emergency department (ED) visits, asthma-related intensive care unit (ICU) admissions, and asthma-attributable costs. RESULTS: A total of 343,520 individuals contributed 2,127,592 patient-years of follow up. Of these, in 190,546 patient-years (7.7%) SABAs were used inappropriately. Inappropriate use of SABAs in any given year was associated with a 45% (odds ratio (OR) = 1.45, 95%CI 1.26-1.66) increase in the risk of asthma-related admissions in the following three-month period. Similarly, inappropriate use of SABA was associated with 25% (OR = 1.25, 95% CI 1.18-1.33) increase in the risk of asthma-related ED visits. The association with ICU admissions was not statistically significant. Inappropriate use of SABA was associated with a 6% (relative rate [RR] = 1.06, 95% CI = 1.04-1.08) increase in total-asthma-related costs. CONCLUSIONS: Inappropriate use of SABA continues to be problematic in a significant minority of asthma patients and is associated with an increased health care utilization and risk of adverse outcomes.
BACKGROUND: Inappropriate use of short-acting beta-agonists (SABA) has been associated with increased morbidity and mortality in asthma. However, the extent and pattern of SABA use have changed significantly over recent years. The outcomes in patients who are contemporarily receiving inappropriate doses of SABA have not been evaluated. METHODS: We used population-based administrative health data from British Columbia (BC), Canada, to create a cohort of asthma patients aged 14 to 55. The exposure of interest was inappropriate use of SABA with any given 12-month period, as defined and validated previously. The primary outcome was asthma-related hospitalization in the following three-month period; secondary outcomes were asthma-related emergency department (ED) visits, asthma-related intensive care unit (ICU) admissions, and asthma-attributable costs. RESULTS: A total of 343,520 individuals contributed 2,127,592 patient-years of follow up. Of these, in 190,546 patient-years (7.7%) SABAs were used inappropriately. Inappropriate use of SABAs in any given year was associated with a 45% (odds ratio (OR) = 1.45, 95%CI 1.26-1.66) increase in the risk of asthma-related admissions in the following three-month period. Similarly, inappropriate use of SABA was associated with 25% (OR = 1.25, 95% CI 1.18-1.33) increase in the risk of asthma-related ED visits. The association with ICU admissions was not statistically significant. Inappropriate use of SABA was associated with a 6% (relative rate [RR] = 1.06, 95% CI = 1.04-1.08) increase in total-asthma-related costs. CONCLUSIONS: Inappropriate use of SABA continues to be problematic in a significant minority of asthma patients and is associated with an increased health care utilization and risk of adverse outcomes.
Authors: Kjell Larsson; Hannu Kankaanranta; Christer Janson; Lauri Lehtimäki; Björn Ställberg; Anders Løkke; Kristian Høines; Klaus Roslind; Charlotte Suppli Ulrik Journal: NPJ Prim Care Respir Med Date: 2020-06-05 Impact factor: 2.871
Authors: Barbara Putman; Louise Coucke; Anna Vanoverschelde; Els Mehuys; Lies Lahousse Journal: BMC Health Serv Res Date: 2022-01-26 Impact factor: 2.655