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Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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6/2023
vol. 40
 
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abstract:
Original paper

Predictors of excessive short-acting b2-agonist use and asthma exacerbations: a retrospective analysis of a Polish prescription database

Maciej Kupczyk
1
,
Wojciech Barg
2
,
Grażyna Bochenek
3
,
Grzegorz Brożek
4
,
Piotr Dąbrowiecki
5
,
Dorota Brzostek
6
,
Andrzej Dąbrowski
7
,
Rafał Dobek
8
,
Radosław Gawlik
9
,
Aleksandra Kucharczyk
10
,
Izabela Kupryś-Lipińska
1
,
Agnieszka Mastalerz-Migas
11
,
Marek L. Kowalski
12

  1. Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
  2. Department of Human Physiology, Medical College of Rzeszów University, Rzeszow, Poland
  3. Department of Internal Medicine, Faculty of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
  4. Department of Epidemiology, School of Medicine Katowice, Medical University of Silesia, Katowice, Poland
  5. Department of Infectious Diseases and Allergology, Military Institute of Medicine, Warsaw, Poland
  6. AstraZeneca Pharma Poland Sp. z o.o., Warsaw, Poland
  7. Department of Internal Medicine, Pneumonology and Allergology, Warsaw Medical University, Warsaw, Poland
  8. Department of Lung Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
  9. Department of Internal Medicine, Allergology and Clinical Immunology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
  10. Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Military Institute of Medicine, Warsaw, Poland
  11. Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
  12. Department of Immunology, Rheumatology and Allergy, Chair of Clinical Immunology and Microbiology, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland
Adv Dermatol Allergol 2023; XL (6): 790-797
DOI: https://doi.org/10.5114/ada.2023.133454
Online publish date: 2024/01/08
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Introduction:
Despite being linked to unfavourable outcomes, short-acting b2-agonists (SABAs) are still overused by a substantial proportion of patients with asthma.

Aim:
To analyse the prevalence and predictors of SABA overuse and exacerbations in patients with asthma in a nationwide database of prescription purchase records.

Material and methods:
The prevalence of excessive SABA use (≥ 12 canisters) and overuse (≥ 3 canisters) was analysed among patients aged 18–64 years who purchased asthma medications in 2018. Predictors of excessive SABA use and SABA overuse were examined by quasi-Poisson regression. Negative binomial regression was used to study the association of excessive SABA use or overuse to the risk of asthma exacerbation defined as a prescription for oral corticosteroids.

Results:
Of 91,763 patients with asthma, 42,189 (46%) were SABA users (mean age, 47 years; 58% female). Among them, 34% purchased ≥ 3 SABA canisters, and 6% purchased ≥ 12 canisters. The risk (risk ratio, 95% CI) of excessive SABA use was lower in patients with concomitant prescriptions for inhaled corticosteroids (0.41, 0.34–0.48) or inhaled corticosteroids and long-acting b2-agonists (0.52, 0.47–0.56), women (0.63, 0.58–0.68), and those in secondary care (0.60, 0.44–0.66); older age was associated with a higher risk of excessive SABA use (1.06, 1.03–1.10). Excessive SABA use was the strongest predictor of asthma exacerbations among all patients (3.24, 2.84–3.70) and in those with ≥ 1 exacerbation (1.60, 1.50–1.71).

Conclusions:
Excessive SABA use is highly prevalent in asthma management, is associated with lack of prescriptions for inhaled corticosteroids, and substantially increases the exacerbation risk.

keywords:

asthma, controller medications, exacerbation, reliever medications, short-acting b2-agonists
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