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Short-acting ß2-agonists and the risk of severe asthma exacerbations

Published: March 28, 2022

The SABA Use IN Asthma (SABINA) program, the largest real-world data analysis of clinical outcomes related to short-acting ß2-agonist (SABA) use and maintenance therapy, has demonstrated that increasing reliance on rescue/reliever inhalers and inadequate coverage of maintenance medication is a public health concern.

In a recently published article in The Journal of Allergy and Clinical Immunology: In Practice, Quint et al report SABINA findings from Europe and North America in over 1 million patients with asthma and describe how differences and similarities across healthcare systems affect the association between SABA prescriptions or possession and severe asthma exacerbations. The authors also investigated whether a safe threshold of SABA use exists and if severe exacerbations for patients using as-needed SABA alone are independent of maintenance therapy.

Findings revealed that approximately 40% of patients across all asthma severities were prescribed or possessed 3 or more SABA canisters per year, which was associated with an increased incidence of severe asthma exacerbations, regardless of maintenance therapy. Despite the different asthma management practices and healthcare systems of each country, results were consistent across Europe and North America. Findings from the United States (US) revealed high asthma morbidity, due to the majority of patients being treated with SABA monotherapy and requiring oral corticosteroid bursts without a face-to-face evaluation by a healthcare practitioner. Approximately, two-thirds of US patients receiving SABA monotherapy and utilizing less than 3 SABA canisters annually experienced 1 or more severe exacerbation. Overall, prescription or possession of 3 or more versus 1-2 SABA canisters per year was associated with a 32% increased incidence of severe asthma exacerbations, independent of maintenance therapy. Even in patients receiving regular maintenance therapy, higher SABA prescriptions were associated with a continuous increase in severe asthma exacerbations. Increasing SABA prescriptions from 1 to 2.7 canisters per year was accompanied by a 20% (considered to be clinically relevant) increased incidence of severe asthma exacerbations. The authors concluded that independent of maintenance therapy, increasing prescriptions or possession of SABA leaves patients at risk of severe exacerbations. Therefore, as supported by international guidelines, symptom-based use of an inhaled corticosteroid-containing rescue/reliever instead of as-needed SABA alone, may be needed to control symptoms and prevent severe exacerbations for all patients with asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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