Short-acting β -agonist use and its ability to predict future asthma-related outcomes

• Published in: Annals of allergy, asthma, & immunology Vol. 109; no. 6; pp. 403 - 407
• Main Authors: Stanford, Richard H., PharmD, MS, Shah, Manan B., PharmD, PhD, D’Souza, Anna O., BPharm, PhD, Dhamane, Amol D., BPharm, MS, Schatz, Michael, MD, MS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier
• Subjects: Adrenergic beta-Agonists - administration & dosage; Adrenergic beta-Agonists - adverse effects; Adult; Allergy and Immunology; Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - adverse effects; Asthma - drug therapy; Biological and medical sciences; Child; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Dermatology; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Logistic Models; Male; Medicaid; Medical sciences; Outcome Assessment (Health Care) - methods; Pneumology; Retrospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Treatment Outcome; United States; United States; Lung disease; Immunopathology; Agonist; Prognosis; Respiratory disease; Dermatology; Use; Prediction; Asthma; Immunology; Bronchus disease; Evolution; Obstructive pulmonary disease; Predictive factor
• ISSN: 1081-1206; 1534-4436
• DOI: 10.1016/j.anai.2012.08.014

Abstract Background Short-acting β -agonist (SABA) use is well established in predicting asthma events in adults. However, this predictive ability has yet to be established in a pediatric population together with an assessment of amount of use. Objective To identify the number of SABA canisters that best predicts future asthma-related exacerbations and the optimal length of time for measurement of SABA use in pediatric and adult asthma patients. Methods Asthma patients were identified from a Medicaid and a commercially insured database (January 1, 2004, through December 31, 2005, and January 1, 2004, through June 30, 2006, respectively). Following the date of first asthma medication, an assessment period (3, 6, or 12 months) was used to measure SABA use. Asthma-related exacerbations were identified in the subsequent 12-month period. Receiver operating characteristic curve analyses and logistic regression were used to select the critical values of SABA use and optimal assessment periods and to conduct incremental analysis, respectively. Results A total of 33,793 Medicaid and 101,437 commercial patients met the study criteria. Use of 3 or more SABA canisters during 12 months was identified in both pediatric Medicaid and commercial populations to best predict an increased risk of an asthma-related exacerbation. For adults, use of 2 or more SABA canisters was found as the critical value with shorter optimal assessment periods of 3 and 6 months. Each additional SABA canister resulted in an 8% to 14% and 14% to 18% increase in risk of an asthma-related exacerbation in children and adults, respectively. Conclusion The study identified critical values of SABA use that predict future asthma events. Each additional SABA canister predicted increases in exacerbation risk in children and adults.