SABA Use Research Articles

Quality of life in children with asthma compared to healthy children: a case-control study

Objective Asthma is a chronic condition characterized by episodic wheezing, cough, and shortness of breath resulting from airway hyperresponsiveness and inflammation. Over 300 million people are affected worldwide, and its prevalence is increasing by 50% every decade. Assessing the quality of life in children with asthma is fundamental, as consistently poor health-related quality of life is associated with poorly controlled asthma. This study is aimed to evaluate and compare factors associated with HRQOL between healthy controls and children with asthma. Methods In the current case-control study, 50 children aged 8–12 years with asthma (cases) enrolled at outpatient hospital clinics by a trained pediatric allergist/immunologist (A.P.) and matched with 50 healthy controls by age and sex. All enrolled subjects were interviewed utilizing the PedsQL questionnaire to assess health-related quality of life; also, patient demographics, including age, sex, and family income status, were obtained from a questionnaire. Results A total of 100 children comprising 62 males and 38 females with a mean age of 9.63 ± 1.38 years, participated in this study. The average score of children with asthma was 81.63 ± 9.38, and the average score for healthy participants was 89.58 ± 7.91. We found that asthma was associated with a significant drop in health-related quality of life in this sample. Conclusions The results indicated that the PedsQL score and its subscales, except social functioning, were significantly higher in children with asthma compared to healthy ones. Also, SABA use, nocturnal symptoms, and asthma severity are negatively related to the health-related quality of life.

Healthcare costs associated with short-acting β2-agonists in asthma: observational UK SABINA study.

Poor asthma control is associated with high short-acting β2-agonist (SABA) use. To assess asthma-related healthcare resource utilisation (HCRU) and medication costs associated with high versus low SABA prescriptions in the UK. Analysis of SABINA I (SABA use IN Asthma I), a retrospective longitudinal study using UK electronic health records (Clinical Practice Research Datalink GOLD 2008-2019 and Hospital Episode Statistics database). Eligible patients were ≥12 years old with SABA prescriptions in the past year. SABA prescriptions (number of canisters per year) were defined as high (≥3) or low (1-2). Association of SABA prescriptions with HCRU was assessed by negative binominal model adjusted for covariates. The UK unit costs from the NHS were applied to estimate total healthcare costs (2020). Medication costs were based on the annual average number of canisters per year per patient. Overall, 186 061 patients with SABA prescriptions were included, of whom 51% were prescribed high SABA. Total annual average costs (HCRU and medication) were 52% higher in the high SABA group versus the low SABA group (£2 256 091 per 1000 patients/year versus £1 480 640 per 1000 patients/year). Medication costs accounted for the majority of asthma-related costs. Across both groups, most HCRU costs were for non-exacerbation-related primary care or hospital outpatient visits. The annual average HCRU cost difference for high SABA versus low SABA was the greatest for hospitalisations (+230%; £15 521 per 1000 patients/year versus £4697 per 1000 patients/year) and exacerbation-related primary care visits (+162%; £18 770 per 1000 patients/year versus £7160 per 1000 patients/year). Asthma-related HCRU extrapolated to the broader UK asthma population was £108.5 million per year higher with high SABA versus low SABA. High SABA versus low SABA prescriptions are associated with higher asthma-related HCRU costs.

The Changing Asthma Management Landscape and Need for Appropriate SABA Prescription.

Short-acting β2 agonists (SABAs) have been a mainstay of asthma treatment since the 1950s, and have been mainly recommended as-needed for symptom relief alongside daily inhaled corticosteroid (ICS)-based maintenance treatment for the past 30years. However, patient adherence to regular ICS-based anti-inflammatory maintenance therapy is frequently poor, leading to SABA overuse for symptom relief and associated poor outcomes. At present, there is a lack of consensus between treatment guidelines on how SABA should be used, and as-needed ICS-formoterol is suggested by some as an alternative reliever therapy. Here, we examine the pharmacology and current use of inhaled SABAs, identify that regular dosing of ICS can encourage appropriate SABA use, and appraise the evidence used to support the changing reliever treatment recommendations. We conclude that SABA continues to play an important role in the asthma management landscape, and give our views on how it should be used in patients with mild-moderate asthma, to complement regular ICS-based maintenance treatment.

Progress to be made in asthma management

Progress to be made in asthma management

СУЧАСНІ ПІДХОДИ ЛІКУВАННЯ БРОНХІАЛЬНОЇ АСТМИ ЗГІДНО GINA 2023

In 1993 there was initiated the Global Initiative for Asthma Management and Prevention. Each year GINA is revised and each subsequent revision contains updated recommendations based on new data. It’s underlined in red throughout GINA 2023 the significance of ICScontaining therapy. The best treatment approach for adults and adolescents remains Track 1 with ICS/formoterol as needed. Track 2 now also includes an ICS/SABA combination as needed as an Anti-inflammatory Reliever (AIR), but Track 1 remains the “preferred” regimen. Although inhaled SABA are highly effective for rapid relief of asthma symptoms, patients whose asthma is treated with SABA alone (compared with ICS) have an increased risk of death and asthma-related emergency medical care needs. For safety reasons, GINA does not recommend SABA alone for the treatment of asthma in adults, adolescents, or children 6–11 years of age. Is it possible to treat asthma without SABA? In an asthma center in Argentina, since 2014, a treatment strategy with ICS-containing symptom relievers has been implemented: using only budesonide/formoterol in a single inhaler across all spectrums of asthma severity and completely excluding the use of SABA. As a result, the level of hospitalization decreased by 92%. The 2023 revision of GINA proposed new terminology for anti-asthma drugs: Maintenance therapy, controller drugs, reliever drugs, anti-inflammatory reliever, Maintenance and Reliever Therapy - MART. Clarifications have been made for the treatment of asthma exacerbations. Added details on drugs and doses of ICS/formoterol on demand and ICS/SABA as needed, MART regimen in individual asthma action plan, how and when to modify these drugs as the disease worsens. The inhaler prescription algorithm is written in more details, considering its impact on the environment. Conclusions: The GINA 2023 updates highlight the most significant role of ICS-containing therapy in achieving asthma control and preventing exacerbations. However, patient adherence to therapy remains quite low, so an approach that allows for the management of both symptoms and exacerbations simultaneously is simpler and remains the preferred way of asthma therapy. Global approaches to asthma management - limiting, where possible, the use of SABA and favoring delivery devices and treatment regimens with less environmental impact. Managing the patient according to his personal action plan and creating local protocols can limit the use of SABA, improve the patient’s asthma outcomes and environmental impact. Key words: asthma, GINA, inhalers, asthma control, exacerbation

Over-prescription of short-acting β2-agonists for asthma in South Africa: Results from the SABINA III study.

Asthma medication prescription trends, including those of short-acting β2 -agonists (SABAs), are not well documented for South Africa (SA). To describe demographics, disease characteristics and asthma prescription patterns in the SA cohort of the SABA use IN Asthma (SABINA) III study. An observational, cross-sectional study conducted at 12 sites across SA. Patients with asthma (aged ≥12 years) were classified by investigator-defined asthma severity, guided by the Global Initiative for Asthma (GINA) 2017 recommendations, and practice type (primary/ specialist care). Data were collected using electronic case report forms. Overall, 501 patients were analysed - mean (standard deviation) age, 48.4 (16.6) years; 68.3% female - of whom 70.6% and 29.4% were enrolled by primary care physicians and specialists, respectively. Most patients were classified with moderate-to-severe asthma (55.7%; GINA treatment steps 3 - 5), were overweight or obese (70.7%) and reported full healthcare reimbursement (55.5%). Asthma was partly controlled/uncontrolled in 60.3% of patients, with 46.1% experiencing ≥1 severe exacerbations in the 12 months before the study visit. Overall, 74.9% of patients were prescribed ≥3 SABA canisters in the previous 12 months (over-prescription); 56.5% were prescribed ≥10 SABA canisters. Additionally, 27.1% of patients reported purchasing SABA over-the-counter (OTC); among patients with both SABA purchase and prescriptions, 75.4% and 51.5% already received prescriptions for ≥3 and ≥10 SABA canisters, respectively, in the preceding 12 months. SABA over-prescription and OTC purchase were common in SA, demonstrating an urgent need to align clinical practices with the latest evidence-based recommendations and regulate SABA OTC purchase to improve asthma outcomes. What the study adds. This study provides valuable insights into asthma medication prescription patterns, particularly SABAs, across SA. Collection of this real-world data in patients treated in primary and specialty care demonstrates that SABA over-prescription and SABA OTC purchase are common, even in patients with mild asthma. These findings will enable clinicians and policymakers to make targeted changes to optimise asthma outcomes across the country Implications of the findings. SABA over-prescription represents a major public health concern in SA. Healthcare providers and policymakers will need to work together to promote educational initiatives aimed at patients, pharmacists and physicians, align clinical practices with the latest evidence-based recommendations, improve access to affordable medications and regulate SABA purchase without prescription.

Proximate composition and antioxidant activity of the saba (Musa acuminata x balbisiana Colla) banana blossom family Musaceae

This study evaluated the proximate composition, and content of phenolic and flavonoid compounds as well as the potential antioxidant property of saba (Musa acuminata x balbisiana Colla) banana blossoms. The banana blossom was dried at 60 ℃ for 12 hours. The sample was then extracted using 80% ethanol. The ethanolic extract of the sample was subjected to antioxidant and various characterization, including the following: i) nutritional values of the banana blossom powder, which was analyzed according to the Association of Official Analytical Chemists (AOAC), ii) total phenol and total flavonoid content and iii) antioxidant test using, 2-diphenyl-1picrylhydrazyl (DPPH) free radical scavenging activity. The results revealed that the sample contains a high amount of ash, fiber, protein, and carbohydrate and a low amount of fat. The Total Phenolic Content and Flavonoid Concentration of extract revealed an abundant reservoir of compounds, the concentration 500 mcg/mL, exhibited the highest radical scavenging activity of banana blossom ethanolic extract, suggesting a dose-dependent activity. Further investigation using other in vitro and in vivo antioxidant assay is recommended to confirm the potential use of saba (Musa acuminata x balbisiana Colla) banana blossom as an antioxidant.

Short-acting β2-agonists over-prescription in patients with asthma: an Indian subset analysis of international SABINA III study

Objective The SABINA (SABA use IN Asthma) program was initiated to describe short-acting β2-agonists (SABA) prescription patterns and assess the impact of its over-prescription on exacerbation risk and asthma control. We evaluated SABA prescription patterns in patients with asthma in the Indian cohort of SABINA III. Methods This multi-centre, observational, cross-sectional study included retrospective and real-time electronic data collection. Data were extracted from medical records of patients with asthma (aged >12 years) having >3 consultations with the same healthcare practitioners between March 2019 and January 2020. The data included prescriptions of SABA and other asthma treatments and over-the-counter (OTC) purchases of SABA. SABA prescriptions were categorized by the number of SABA canisters prescribed in the 12 months preceding the study visit. Results A total of 510 patients with asthma were included from specialist care (mean age 49.1 years; 57.65 females), with 8.2% classified with mild asthma and 91.8% with moderate-to-severe asthma. SABA as monotherapy and add-on to maintenance therapy was prescribed to 4.5% (n = 23) and 44.9% (n = 229) of patients, respectively. While ICS monotherapy and ICS/LABA were prescribed to 5.1% (n = 26) and 93.3% (n = 476) of patients, respectively. SABA was found to be over-prescribed (≥3 SABA canisters/year) among 23.9% of patients (n = 122). Additionally, 8% of patients (n = 41) purchased SABA OTC without prescription. Conclusions Nearly one-fourth of patients with asthma in India were over-prescribed SABA. Educational programmes targeted at national and regional levels should be expanded to raise greater asthma awareness and encourage the adoption of guideline-directed asthma treatment plans among healthcare practitioners.

Short-acting β2 -agonist use and asthma exacerbations in Swedish children: A SABINA Junior study.

In adults and adolescents with asthma, use of ≥3 short-acting β2 -agonist (SABA) canisters/year is associated with increased exacerbation risk. Whether this association is present in younger children remains unknown. In this SABA use IN Asthma (SABINA) Junior study, we assessed the association of SABA collection with exacerbation risk in the general Swedish pediatric asthma population. This population-based cohort study utilized linked data from the Swedish national healthcare registries involving patients with asthma (<18 years) treated in secondary care between 2006-2015. Exacerbation risk, by baseline SABA collection (0-2 vs. ≥3 canisters, further examined as ordinal/continuous variable) and stratified on comorbid atopic disease (allergic rhinitis, dermatitis and eczema, and food/other allergies), was assessed for 1-year follow-up using negative binomial regression. Of 219,561 patients assessed, 45.4%, 31.7%, and 26.5% of patients aged 0-5, 6-11, and 12-17 years, respectively, collected ≥3 SABA canisters during the baseline year (high use). Collection of ≥3 SABA canisters (vs. 0-2) was associated with increased exacerbation risk during follow-up (incidence rate ratios [95% confidence interval]: 1.35 [1.29-1.42], 1.22 [1.15-1.29], and 1.26 [1.19-1.34] for 0-5-, 6-11-, and 12-17-year-olds, respectively); the association persisted with SABA as a continuous variable and was stronger among patients without atopic diseases (32%-44% increased risk versus. 14%-21% for those with atopic disease across groups). High SABA use was associated with increased asthma exacerbation risk in children, particularly in those without comorbid atopic diseases, emphasizing the need for asthma medication reviews and reformative initiatives by caregivers and healthcare providers on SABA use.

Efficiency of using a short-acting β2-agonist for the relief of acute cold bronchospasm in asthma patients with cold airway hyperresponsiveness

Excessive sensitivity of the respiratory tract to physical and chemical environmental triggers can vary for many reasons, reducing the therapy effectiveness in a patient with asthma. Aim of the study was to investigate the effectiveness of a short-acting bronchodilator in patients with asthma for the relief of acute cold bronchospasm after a test of isocapnic cold air hyperventilation (ICHV). Material and methods. In 281 (161 women; 120 men, p &gt; 0.05) asthma patients with cold airway hyperresponsiveness (CAHR), the change in airway patency (FEV1) and the efficacy of short-acting β2-agonists (SABA) after a 3-minute isocapnic hyperventilation with cold (–20 ºС) air. Results. According to clinical data, patients had persistent asthma, mean age 35 (26; 44) years, 49 % of patients smoked, ACT 16 (12; 20) points, FEV1 90.0 ± 1.0 % predicted, FEV1/VC 71.4 ± 0.6 %, the increase in FEV1 after inhalation of SABA (∆FEV1β) was 11.1 (5.1; 20.5) %. The change in FEV1 for the ICHV varied within –16 (–22.0; –12.0) %. The use of SABA after the IHCV showed different efficacy for relief of an attack of cold bronchospasm. The median value of ∆FEV1β after ICHV was 21.1 (11.6; 33.3) %, with a range of –48.6 to 108.2 %. In the general group, there was a direct relationship between the level of asthma control in terms of ACT points and the baseline FEV1 (Rs = 0.17; p = 0.007), MEF25-75 (Rs = 0.18; p = 0.008), ∆FEV1β in response to SABA (Rs = –0.17; p = 0.0104), as well as the severity of the bronchial response to the ICHV (Rs = 0.15; p = 0.014). The latter, in turn, correlated with ∆FEV1β after ICHV (Rs = –0.28; p &lt; 0.0001) after HCI. Conclusions. There is a differentiated airway response to SABA after acute cold bronchoprovocation. The results obtained can serve as an important tool for phenotyping of asthma patients with CAHR for the medication correction of сold bronchospasm.

Overprescription of short-acting β2 -agonists among patients with asthma in Saudi Arabia: Results from the SABINA III cohort study.

Despite near-universal health care and timely updates to treatment guidelines in Saudi Arabia, asthma control remains suboptimal, warranting deeper exploration of its management practices. This study describes asthma characteristics and prescription patterns of short-acting β2 -agonists (SABAs) in the Saudi Arabia cohort of the SABA use IN Asthma (SABINA) III study. Patients with asthma (aged ≥12 years) from seven sites across Saudi Arabia participated in this cross-sectional study. Asthma severity was classified by study investigators, guided by the 2017 Global Initiative for Asthma (GINA) recommendations. Of 511 patients enrolled, 502 patients, treated by respiratory medicine specialists, were analyzed (mean [standard deviation] age, 47.5 [14.8] years; female, 68.5%). Most patients had moderate-to-severe asthma (89.6%, GINA treatment steps 3-5), were overweight/obese (78.9%), and received full health care reimbursement (83.4%). Asthma was partially controlled/uncontrolled among 64.3% of patients; 62.3% experienced ≥1 severe asthma exacerbation(s), and 60.6% and 41.2% were prescribed ≥3 (overprescription) and ≥10 SABA canisters, respectively, in the 12 months preceding study initiation. Additionally, 21.9% of patients purchased SABA over the counter (OTC), of whom 66.4% purchased ≥3 SABA canisters. Ninety-seven (88.2%) patients who purchased SABA OTC also received SABA prescriptions, and 80.4% and 56.7% of these were prescribed ≥3 and ≥10 SABA canisters, respectively. Overall, compared with SABINA III, a higher percentage of patients from Saudi Arabia were overprescribed SABA (60.6% vs. 38.0%, respectively) and purchased SABA OTC (21.9% vs. 18.0%, respectively), underscoring the need to align asthma treatment practices with current evidence-based recommendations and regulate SABA OTC sales in Saudi Arabia.

Severe asthma and long-term Benralizumab effectiveness in real-life.

Long-term efficacy of Benralizumab in real life is not clearly known. We assessed the long-term effectiveness persistence to anti-IL-5R treatment in a group of severe eosinophilic asthmatics. We retrospectively analyzed 95 individuals affected by severe asthma (36 males ̶ 37.9%; mean age 58.1 ± 12.2) treated with Benralizumab (mean time 19.7 ± 7.2 months, range 12-35). Outcomes were evaluated at the beginning and at the end of patients' treatment periods. Mean baseline blood eosinophils were 897.5 ± 720.1 cells/μL (11 ± 5.6%) decreasing to 7.4 ± 20.6 cells/μL (0.97 ± 0.26%; p < 0.0001) after Benralizumab. FENO likewise decreased from 63.9 ± 68.4 to 28.4 ± 23.6 ppb, while FEV1% significantly improved (p < 0.0001). Mean FEF25-75 also increased from 45.8 ± 24.6% to 60.7 ± 24.6%, whereas RAW dropped from 202.15 ± 109.6% to 135.2 ± 54.75% (p < 0.0001). Also, lung volumes greatly decreased. ACT/ACQ significantly improved, while exacerbations number fell from 4.1 ± 2.4, before anti-IL-5R, to 0.33 ± 0.77, after treatment (p < 0.0001). Rhinitis severity levels and SNOT-22 also changed favorably. Patients that took long-term OCs were 71.6% before treatment, decreasing to 23.2% after Benralizumab (p < 0.0001), with an OCs dose reduction from 14.8 ± 8.9 to 1.45 ± 2.8 mg/day (p < 0.0001). 51.6% of subjects used SABA as needed before Benralizumab, falling to 4.2% after treatment. Several patients showed a reduction of ICS doses, SABA use and maintenance therapy step-down. Clinical/biological response with anti-IL-5R remained constant or even improved in terms of exacerbations or maintenance therapy reductions over time. On the contrary, FEF25-75% improvement slowed down in the long-term. No relationship was found between baseline blood eosinophil number and therapeutic response. Long-term Benralizumab effectiveness persistence in all outcomes in real life was confirmed.

Short-acting β2-agonist prescription patterns for asthma management in the SABINA III primary care cohort

Short-acting β2-agonist (SABA) prescriptions and associated outcomes were assessed in 1440 patients with asthma from the SABA use IN Asthma (SABINA) III study treated in primary care. Data on asthma medications were collected, and multivariable regression models analysed the association of SABA prescriptions with clinical outcomes. Patients (mean age, 47.9 years) were mostly female (68.6%); 58.3% had uncontrolled/partly controlled asthma and 38.8% experienced ≥1 severe exacerbation (reported in 39% of patients with mild asthma). Overall, 44.9% of patients were prescribed ≥3 SABA canisters (over-prescription) and 21.5% purchased SABA over-the-counter. Higher SABA prescriptions (vs 1−2 canisters) were associated with significantly decreased odds of having at least partly controlled asthma (6–9 and 10–12 canisters) and an increased incidence rate of severe exacerbations (10–12 and ≥13 canisters). Findings revealed a high disease burden, even in patients with ‘mild’ asthma, emphasising the need for local primary care guidelines based on international recommendations.

Overuse of short-acting β2 -agonists in the Russian population with asthma: the persisting threat

Short-acting β2 -agonists (SABA) overuse is associated with negative outcomes in asthma patients. There is a lack of actual data about patterns of SABA overuse in the Russian population with asthma.The aim. To investigate patterns of SABA overuse in the Russian population with asthma.Methods. Data from the Russian population of “SABA use IN Asthma (SABINA) III” study were analyzed. SABINA III was a cross-sectional observational study covering 24 countries. Adults and adolescents with a documented diagnosis of asthma for at least 12 months were enrolled in the study. Data on disease characteristics and asthma treatments during previous 12 months were collected using real-time electronic case report forms and were analyzed with methods of descriptive statistics.Results. Majority of the Russian population (n = 618) consisted of patients with moderate/ severe asthma (78.5%). Asthma was uncontrolled or partly controlled in 70% of patients. SABA over-prescription (≥ 3 canisters per year) was seen in 37% of patients. The frequency of SABA over-prescription was similar in patients with mild (35%) and moderate/severe (38%) asthma. SABA was purchased over-the-counter (OTC) in the past 12 months by 30% of all patients, while 14% purchased ≥ 3 canisters of SABA per year. More than 90% of patients who purchased SABA OTC, already received prescriptions for SABA, of whom 59% were prescribed ≥ 3 canisters per year.Conclusion. Russia is faced with very high level of SABA overuse. Over-prescription is the main cause for SABA overuse. To reduce SABA overuse, it is necessary to educate both patients and doctors, and actively implement up-to-date asthma treatments.

Blood plasma cathepsin S in severe bronchial asthma

The aim. To determine the level of cathepsin S and to identify its possible relationships with clinical, functional and laboratory indicators in patients with severe bronchial asthma.Methods. 114 patients with severe bronchial asthma were examined. 96 women (84.2%) and 18 (15.8%) men were divided into 2 groups: allergic and non-allergic severe bronchial asthma. The external respiration function was assessed with whole-body plethysmography (“Erich Jaeger”, Germany). The plasma concentration of cytokines IL-4, IL-5, IL-13, periostin, cathepsin S, TGF-β was estimated with ELISA (“eBioscience”, USA).Results. Fixed obstruction is reported in 48% and 50% of cases of allergic and non-allergic severe asthma, respectively. Peripheral blood eosinophilia occurs in 41.5% of cases with allergic and in 25% of cases with non-allergic asthma. IL-5, IL-13, and cathepsin S levels were increased in both groups. An increase in IL-4 and TGF-β levels was revealed in non-allergic asthma. Periostin levels were increased in patients with allergic asthma as compared with the control and the second group. Positive correlation between cathepsin S and concentration of IL-4, IL-5 was established in both groups. We identified weak positive correlation between cathepsin S levels and clinical symptoms of the disease, such as frequency of SABA use and asphyxiation attacks, only in the allergic asthma group. A positive correlation between cathepsin S and TGF-β was established in both groups.Conclusion. A positive correlation between serum cathepsin S and TGF-β was established in both allergic and non-allergic severe bronchial asthma. The found moderate relationship may indirectly indicate the involvement of cathepsin S in airway remodeling processes regardless of the disease type.

Step-in step-down approach in the management of bronchial asthma in adolescents and adults.

Despite the step-up step-down approach of asthma management suggested by the Global Initiative for Asthma (GINA), control of asthma continues to be poor. It was hypothesized that a new "Step-in Step-down approach" could prove to be a better alternative. The present study was carried out with the objective to assess the efficacy and adverse effects of this new approach in the control of asthma. All treatment-naïve asthma patients were randomly allocated to either Group I (patients received budesonide 400 μg + formoterol 6 μg twice daily via dry powder inhalation device along with as-needed salbutamol) or Group II (patients received stepwise treatment as per GINA guidelines, 2017). Patients were monitored on a fortnightly basis for control of symptoms, spirometry, and complications if any. Asthma Control Questionnaire (ACQ-7) was used to assess control of asthma. Adverse effects, if any, were recorded and managed appropriately. Step-down was attempted on achieving sustained control of asthma, i.e., ACQ score of <0.75 on two consecutive fortnight assessments in both the groups. In Group I patients, long-acting β2-agonist was withdrawn first. Subsequently, a dose of budesonide was also reduced. In Group II patients, the treatment was decreased to the next lower step medicines as per the GINA guidelines. After exclusions, a total of 787 patients were randomized to either Group I or II. The demographic profile of patients in the two groups was similar. Patients on "step-in step-down" approach had a statistically significant advantage over those on conventional step-up step-down approach in terms of (a) time to the first control (271 vs. 98 within first 4 weeks), (b) need for rescue steroids (two patients in Group 1 vs. 40 in Group 2), (c) number of exacerbations (30 vs. 232), and (d) use of rescue SABA (Only 30 patients in group I required > 5 inhalations per week as compared to all in group II). Adverse reactions were not observed in any of the patients in either group. We conclude that step-in step-down approach is a more robust and safer approach for control of asthma.

Over-prescription of short-acting β2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study

Background The extent of short-acting β2-agonist (SABA) overuse in Africa remains poorly documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions/clinical outcomes in 3 African countries. Methods Data on disease characteristics/asthma treatments were collected from patients (≥12 years) using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed associations between SABA prescriptions and outcomes. Results Data from 1778 patients (mean age, 43.7 years) were analyzed. Most patients were female (62.4%) and had moderate-to-severe asthma (63.3%), with 57.1 and 42.9% of patients treated in specialist and primary care, respectively. Asthma was partly controlled/uncontrolled in 66.2% of patients, with 57.9% experiencing ≥1 severe exacerbation in the previous 12 months. Overall, 46.5% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (over-prescription); 26.2% were prescribed ≥10 canisters. SABAs were purchased over-the-counter by 32.6% of patients, of whom 79.3% had received SABA prescriptions; 71.9% and 40.1% for ≥3 and ≥10 canisters, respectively. Higher SABA prescriptions (vs. 1–2 canisters) were associated with increased incidence rate of severe exacerbations and lower odds of having at least partly controlled asthma (except 3–5 canisters). Conclusions Findings from this African cohort of the SABINA III study indicate that SABA over-prescription and SABA over-the-counter purchase are common and associated with poor asthma-related outcomes. This highlights the need for healthcare providers/policymakers to align clinical practices with the latest treatment recommendations.

Asthma-related hospitalizations after implementing SABA-free asthma management with a maintenance and anti-inflammatory reliever regimen

ABSTRACT Overreliance on short-acting β2-agonists (SABA) has been a common feature of asthma management globally for at least 30 years. However, given the evidence against the long-term use of SABA, including potentially increased risk of exacerbations, emergency room visits, overall healthcare resource utilization, and mortality, the latest Global Initiative for Asthma report no longer recommends SABA only therapy. Since 2014, we implemented an ICS-containing reliever strategy at our asthma center at the G Baigorria Hospital in Argentina; we only administered budesonide/formoterol via a single inhaler device across the spectrum of asthma severity and completely eliminated the use of SABA therapy. In this article, we compare hospitalization data from our center, previously reported in the EAGLE study (when inhaled corticosteroids plus as-needed SABA was administered) for the years 1999 and 2004 with data from 2017 to 2018 (when budesonide/formoterol in a single inhaler device was administered as maintenance and/or anti-inflammatory reliever therapy [MART/AIR] without any SABA) from our center, to assess the impact of two distinct asthma management strategies on asthma-related hospitalizations. MART/AIR regimens in our SABA-free center reduced asthma hospitalizations from 9 (1999 and 2004) to 1 (2017 and 2018) (Fisher’s exact test, p = 0.031; odds ratio = 0.11; 95% confidence interval [CI] = 0.013–0.98); the hospitalization rate was reduced by 92% (1.47% in 1999 and 2004 to 0.12% in 2017 and 2018). Our data provide preliminary real-world evidence that MART/AIR with budesonide/formoterol simultaneously with SABA elimination across asthma severities is an effective asthma management strategy for reducing asthma-related hospitalizations.

A Cross-Sectional Study on Prescription Patterns of Short-Acting β2-Agonists in Patients with Asthma: Results from the SABINA III Colombia Cohort.

PurposeOveruse of short-acting β2-agonists (SABAs) for asthma is associated with a significant increase in exacerbations and healthcare resource use. However, limited data exist on the extent of SABA overuse outside of Europe and North America. As part of the multi-country SABA use IN Asthma (SABINA) III study, we characterized SABA prescription patterns in Colombia.Patients and MethodsThis observational, cross-sectional cohort study of SABINA III included patients (aged ≥12 years) with asthma recruited from seven sites in Colombia. Demographics, disease characteristics (including investigator-defined asthma severity guided by the 2017 Global Initiative for Asthma report), and asthma treatments prescribed (including SABAs and inhaled corticosteroids [ICS]) in the 12 months preceding the study were recorded using electronic case report forms during a single study visit.ResultsOf 250 patients analyzed, 50.4%, 33.2%, and 16.4% were enrolled by pulmonologists, general medicine practitioners, and allergists, respectively. Most patients were female (74.0%) and had moderate-to-severe asthma (67.6%). Asthma was partly controlled or uncontrolled in 57.6% of patients, with 15.6% experiencing ≥1 severe exacerbation 12 months before the study visit. In total, 4.0% of patients were prescribed SABA monotherapy and 55.6%, SABA in addition to maintenance therapy. Overall, 39.2% of patients were prescribed ≥3 SABA canisters in the 12 months before the study visit; 25.2% were prescribed ≥10 canisters. Additionally, 17.6% of patients purchased SABAs over the counter, of whom 43.2% purchased ≥3 canisters. Maintenance medication in the form of ICS or ICS/long-acting β2-agonist fixed-dose combination was prescribed to 36.0% and 66.8% of patients, respectively.ConclusionOur findings suggest that prescription/purchase of ≥3 SABA canisters were common in Colombia, highlighting a public health concern. There is a need to improve asthma care by aligning clinical practices with the latest evidence-based treatment recommendations to improve asthma management across Colombia.

Developing a Smartphone Application That Promotes Responsible Short-Acting Beta2-Agonist Use in People with Asthma: A Participatory Design.

Around 339 million people worldwide have asthma, and 50% have uncontrolled asthma. One trait of uncontrolled asthma, often seen in primary care, is short-acting β2-agonist (SABA) overuse, defined as using SABA more than twice a week. SABA overuse can cause adverse health effects. An application could help patients gain more insight into their SABA use. Engaging stakeholders during the development is important to maximize the usability of and adherence to an application. This study describes the development process of an application that promotes responsible SABA use in people with asthma, using a participatory design. Different stakeholder groups were involved in two iterative development cycles. In the first cycle, four end-users evaluated the app’s prototype. During the second cycle, five end-users were interviewed about the usability of the new version. Resulting in an app that allows patients to register SABA use, asthma symptoms, and symptom triggers. A graph shows how these factors are related, and end-users can show the graph to their physician to facilitate communication. Medication use is compared to the medical guidelines or, when applicable, to the advice given by the users’ healthcare professionals. End-users found the app helpful. Research into the usability and effectiveness of the app in a bigger sample will follow.