Increased use of short-acting β2-agonist (SABA) is associated with an increased risk of asthma exacerbations in children, especially in those without comorbid atopic diseases, according to study findings published in Pediatric Allergy and Immunology.
In follow-up to a study showing that increased SABA use was associated with increased exacerbation risk among adults and adolescents (SABINA International; ClinicalTrials.gov Identifier: NCT03857178), investigators in Sweden conducted a population-based retrospective study (SABINA Junior) to determine if there was an association between SABA use and exacerbations in pediatric patients with asthma.
The investigators used data from Swedish national health care registries to identify participants, all of whom were aged 0 to 17 years, had physician-diagnosed asthma, and had experienced at least 1 asthma-related hospital visit. Outcomes were evaluated for 1 and 3 years following the patient’s hospital visit.
Participants were divided into 2 groups based on the number of SABA canisters they collected in a 1-year period (0 to 2 canisters vs more than 3 canisters). The primary study outcome was incidence of asthma exacerbations (defined as hospitalization, asthma-related emergency room visit, or an oral corticosteroid claim for asthma treatment) during follow-up.
A total of 219,561 patients (40.2% female) were analyzed — 52.1% aged 0 to 5 years; 26.5% aged 6 to 11 years; and 21.4% aged 12 to 17 years. Comorbid atopic disease was present in 21.9% of those aged 0 to 5 years, 49.1% of those aged 6 to 11 years, and 58.5% of patients aged 12 to 17 years.
At baseline, at least 3 SABA canisters were claimed by 45.4% of participants aged 0 to 5 years, 31.7% of those aged 6 to 11 years, and 26.5% of those aged 12 to 17 years.
Adjusted multivariable analysis across age groups showed that collecting at least 3 SABA canisters vs 0 to 2 canisters at baseline was associated with an increased exacerbation rate at 1 year, and with an incidence rate ratios (IRRs) of 1.35 for patients aged 0 to 5 years (95% CI, 1.29-1.42), 1.22 for patients aged 6 to 11 years (95% CI, 1.15-1.29), and 1.26 for patients 12 to 17 years (95% CI, 1.19-1.34).
Additionally, the collection of at least 3 vs 0 to 2 SABA canisters at baseline was associated with an increased risk of any asthma exacerbation at 1 year in patients with nonatopic disease vs atopic disease. Comparative incidence rate ratios for those with nonatopic disease vs those with atopic disease for patients aged 0 to 5 years were 1.44 vs 1.21 (95% CIs, 1.35-1.54 vs 1.12-1.31), respectively; 1.32 vs 1.14 (95% CIs, 1.17-1.49 vs 1.07-1.22), respectively, for patients aged 6 to 11 years; and 1.44 vs 1.20 (95% CIs, 1.27-1.64 vs 1.12-1.28), respectively, for patients aged 12 to 17 years. Moreover, this same trend persisted at the 3-year follow-up. Comparable results were found regarding the risk of first exacerbation, overall and when stratified based on atopic disease, regardless of the length of the follow-up period.
Notably, the predicted rate of exacerbations of any type at 1 year increased with higher baseline SABA canister collection, after stratification by presence of atopic disease.
The researchers noted that results for children aged 0 to 5 years were exploratory owing to potential misclassification of asthma diagnoses; that registry-based data reporting pharmacy collections may not reflect actual medication use; and that stockpiling of canisters was possible. Furthermore, findings were not adjusted for inhaled corticosteroid medication adherence, and only patients in with at least 1 asthma-related hospital visit were included.
The investigators concluded that “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.”
Disclosure: This study was funded by AstraZeneca. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Melén E, Nwaru BI, Wiklund F, et al. Short-acting β2-agonist use and asthma exacerbations in Swedish children: A SABINA Junior study. Pediatr Allergy Immunol. 2022;33(11):e13885. doi: 10.1111/pai.13885