Abstract
BackgroundUnderstanding factors associated with the inappropriate or excessive use of short-acting beta agonists (SABA) can help develop better policies.MethodsWe used British Columbian (BC)‘s administrative health data (1997–2014) to create a retrospective cohort of asthma patients aged between 14 and 55 years. The primary and secondary outcomes were, respectively, inappropriate and excessive use of SABA based on a previously validated definition. Exposures were categorised into groups comprising socio-demographic variables, indicators of type and quality of asthma care, and burden of comorbid conditions.Results343,520 individuals (56.3% female, average age 30.5) satisfied the asthma case definition, contributing 2.6 million person-years. 7.3% of person-years were categorised as inappropriate SABA use and 0.9% as excessive use. Several factors were associated with lower likelihood of inappropriate use, including female sex, higher socio-economic status, higher continuity of care, having received pulmonary function test in the previous year, visited a specialist in the previous year, and the use of inhaled corticosteroids in the previous year. An asthma-related outpatient visit to a general practitioner in the previous year was associated with a higher likelihood of inappropriate SABA use. Similar associations were found for excessive SABA use with the exception that visit to respirologist and the use of systemic corticosteroids were associated with increased likelihood of excessive use.ConclusionsDespite proven safety issues, inappropriate SABA use is still prevalent. Several factors belonging to patients’ characteristics and type/quality of care were associated with inappropriate use of SABAs and can be used to risk-stratify patients for targeted attempts to reduce this preventable cause of adverse asthma outcomes.
Highlights
Understanding factors associated with the inappropriate or excessive use of short-acting beta agonists (SABA) can help develop better policies
The following databases were available to us: 1-Discharge Abstracts Database (DAD) containing hospitalisation information including admission date and up to 25 discharge diagnoses coded using international classification of diseases, 9th (ICD-9) or 10th (ICD-10) revisions [15], 2-Medical Services Plan (MSP) which contains all outpatient services dates, diagnosis, and costs [16], 3-PharmaNET, which contains dispensation information such as unique drug identifier, service date, dispensed quantities and days of supply, and medication and services costs [17], 4-Vital Statistics database, which contains information on deaths [18], 5-Demographics and Census databases, which contain basic demographic information such as date of birth, sex [19], and census database containing socioeconomic status [20]
We evaluated the association between several patientand care-related factors and inappropriate/excessive use of SABAs
Summary
Understanding factors associated with the inappropriate or excessive use of short-acting beta agonists (SABA) can help develop better policies. Reliever medications such as short-acting beta agonists (SABAs) are associated with the rapid resolution of symptoms but do not affect the underlying inflammatory process [1]. We have documented a steady decline (5.3% annually) in inappropriate SABA use over a 12-year period in British Columbia (BC), Canada [13]. Such a trend implies that the composition of patients exposed to inappropriate doses of SABAs is rapidly
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