The impact of inappropriate use of short acting beta agonists in asthma.
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.
['FitzGerald|J Mark|JM|', 'Tavakoli|Hamid|H|', 'Lynd|Larry D|LD|', 'Al Efraij|Khalid|K|', 'Sadatsafavi|Mohsen|M|']
D000293:Adolescent D000318:Adrenergic beta-Agonists D000328:Adult D001249:Asthma D001955:British Columbia D015331:Cohort Studies D004636:Emergency Service, Hospital D005260:Female D017048:Health Care Costs D006760:Hospitalization D006801:Humans D057970:Inappropriate Prescribing D007362:Intensive Care Units D008297:Male D008875:Middle Aged D016017:Odds Ratio D055815:Young Adult
Asthma Short-acting beta-agonists Outcomes Costs Reliever therapy