Thank you Peter and Paul

Abstract

<b>Background:</b> Safety concerns around the use of as-needed short-acting β₂-agonist (SABA) monotherapy in asthma management warrant evaluation. The SABa use IN Asthma (SABINA) programme captures the current global burden of SABA use. <b>Objective:</b> To examine the extent of SABA use and its association with exacerbations in Western societies. <b>Methods:</b> Data from SABINA (Canada, France, Poland, Spain, Sweden, the Netherlands and the UK) and the US (commercial insurance populations, Medicaid and Medicare) were analysed. SABA prescription data (categorised as ≤2 or ≥3 canisters/year), exacerbations and other covariates from patients with asthma (≥12 years) were obtained from electronic medical records, national patient registries and pharmacy prescriptions. <b>Results:</b> Overall, 1,490,336 patients with asthma were included in the analysis. Across all countries and asthma severities, between 15.7% (The Netherlands) and 46.9% (US Medicaid) of patients filled prescriptions for ≥3 SABA canisters/year. Annual SABA canister fills of ≥3 vs. ≤2 were associated with higher odds of having ≥1 asthma exacerbation/year across countries (odds ratio [confidence interval] ranging from 1.09 [1.02–1.16] for the older US Medicare population to 1.89 [1.70–2.11] for the overall Canada population). <b>Conclusion:</b> SABA use of ≥3 canisters/year was common across a large group of countries with diverse healthcare systems and was associated with increased asthma exacerbations. These results support the GINA recommendations about the need to eliminate SABA monotherapy. These findings also highlight the need for careful monitoring of patients with asthma using ≥3 SABA canisters/year and a detailed understanding of the relationship between SABA use and exacerbations.