Use of short-acting beta-2 agonists (SABA) and exacerbations in children and adolescents - a nationwide Swedish asthma cohort (HERA)

Clinical Research Results Abstract IntroductionThe Global Initiative for Asthma (GINA) no longer recommends short-acting β2-agonists (SABAs) alone as initial treatment for mild asthma in patients ≥6 years old.1 High use of SABAs in asthma is a clinical concern, as it does not treat the underlying inflammation. Data on the extent of SABA use in children remain limited. We thus investigated SABA usage in children and its association with asthma exacerbations in Sweden.MethodsWe linked data from the Swedish population-based national healthcare registries for patients (6–17 years) who had a first asthma diagnosis in secondary care during 2006–2015. Baseline SABA collection was determined during the subsequent year. Patients were then followed up for 12 months for asthma exacerbations (hospitalisation, emergency room visits or oral corticosteroid claims). Negative binomial regression was used to estimate the incidence rate ratio (IRR) for asthma exacerbations by baseline SABA collection and adjusted for sex, GINA treatment steps and baseline exacerbation history.ResultsOf 105,183 patients assessed, 58,228 (55.4%) were aged 6–11 and 46,955 (44.6%), 12–17 years. A total of 31.7% and 26.5% of 6–11- and 12–17-year-olds, respectively, collected ≥3 SABA canisters during the baseline year. Across age groups, ≥3 versus 0–2 SABA collection at baseline was associated with an increased rate of exacerbations during follow-up (IRR [95% CI]: 1.22 [1.15–1.29] and 1.26 [1.19–1.34] for 6–11 and 12–17-year-olds, respectively, Table 1). SABA collection, assessed as an ordinal and continuous variable, was also associated with increased exacerbation risk. DiscussionAmong children with an asthma diagnosis in secondary care in Sweden, high SABA use was common and was associated with an increased risk of exacerbations during follow-up. These results highlight that the risk of high SABA use, previously shown in adults,2 persists in children. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest The study was designed and funded by AstraZeneca. References and Clinical Trial Registry Information Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. https://ginasthma.org/gina-reports/ (2021)Nwaru, B. I. et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Respir. J. 55, 1901872 (2020).