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Overuse of short-acting β2-agonists increases sepsis

Published: January 29, 2022

Short-acting β-agonists (SABAs) overuse could be associated with increased acute exacerbations and mortality in patients with asthma. However, the association between SABAs and the risk of sepsis has not been well studied.

In a recent article in The Journal of Allergy and Clinical Immunology (JACI), Lai and colleagues conducted a retrospective study to investigate the association between the overuse of SABAs and sepsis in asthma patients. They used the Taiwan asthma pay-for-performance program database to retrieve the clinical data for asthma patients aged 12-100 years between 2001 and 2013.  SABA overuse was defined as the asthma patients using ≥3 SABA canisters annually. Outcomes including sepsis and septic shock using ICD-9-CM were assessed during the follow-up period.

Initially, a total of 28,033 patients were found to have overused SABAs (overuse group) and 155,453 patients had acceptable SABAs use (control group, defined as the use of 0 to 2 SABA canisters per year). Then, the propensity score matching method with 1:1 ratio was used to yield two subgroups with similar baseline characteristic and each group had 20,542 patients.

The incidence of sepsis during the follow-up period was 1.26 per 100 person-years in the SABA overuse group, which was higher than in the control group (0.94 per 100 person-years). The crude and adjusted hazard ratios (HRs) were 1.35 (95% CI, 1.26-1.44) and 1.33 (95% CI, 1.24-1.43), respectively. The incidence of septic shock during the follow-up period was 0.44 per 100 person-years in the SABA overuse group, which was higher than in the control group (0.33 per 100 person-years). The crude and adjusted HRs were 1.32 (95% CI, 1.17-1.48) and 1.28 (95% CI, 1.14-1.44), respectively.

Based on these findings, the authors concluded that SABA overuse could be associated with an increased risk of sepsis and septic shock in patients with asthma and suggested that efforts should therefore be made to reduce SABA overuse in the treatment of asthma.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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