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

Abstract

Objective

Short-acting β₂-agonist (SABA) over-reliance is associated with poor asthma outcomes. As part of the SABA Use IN Asthma (SABINA) III study, we assessed SABA prescriptions and clinical outcomes in patients from six Latin American countries.

Methods

In this cross-sectional study, data on disease characteristics/asthma treatments were collected using electronic case report forms. Patients (aged ≥12 years) 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 the associations between SABA prescriptions and clinical outcomes.

Results

Data from 1096 patients (mean age, 52.0 years) were analyzed. Most patients were female (70%), had moderate-to-severe asthma (79.4%), and were treated by specialists (87.6%). Asthma was partly controlled/uncontrolled in 61.5% of patients; 47.4% experienced ≥1 severe exacerbation in the previous 12 months. Overall, 39.8% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (considered over-prescription). SABA canisters were purchased over the counter (OTC) by 17.2% of patients, of whom 38.8% purchased ≥3 canisters in the 12 months prior. Of patients who purchased SABA OTC, 73.5% were prescribed ≥3 SABA canisters. Higher SABA prescriptions (vs. 1 − 2 canisters) were associated with an increased incidence rate of severe exacerbations (ranging from 1.31 to 3.08) and lower odds ratios of having at least partly controlled asthma (ranging from 0.63 to 0.15).

Conclusions

SABA over-prescription was common in Latin America, highlighting the need for urgent collaboration between healthcare providers and policymakers to align clinical practices with the latest evidence-based recommendations to address this public health concern.

Keywords:

• Epidemiology
• management/control
• treatment

Acknowledgement

Writing and editorial support was provided by Cactus Life Sciences (part of Cactus Communications, Mumbai, India) in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3) and fully funded by AstraZeneca.

Author’s contributions

All authors contributed to data collection, data analysis, data interpretation, and writing of the manuscript. The study was designed by Maarten J. H. I. Beekman. All authors had full access to all the data in the study and accept responsibility to submit the manuscript for publication.

Declaration of interest

Felicia Montero-Arias has participated in clinical studies sponsored by AstraZeneca and Novartis. She has also participated in conferences and advisory boards sponsored by AstraZeneca and Novartis. Jose Carlos Herrera Garcia has participated in clinical studies funded by AstraZeneca, Novartis, and Boehringer Ingelheim. He has also served as a speaker in international congresses and as principal editor at Intech Open Library. Manuel Pacheco Gallego has served on speakers’ bureaus for AstraZeneca, Roche, Novartis, Novamed, Bayer, Boehringer Ingelheim, Scandinavia Pharma, and Janssen. Martti Anton Antila has participated in clinical studies funded by AstraZeneca, Sanofi Genzyme, EMS, Eurofarma, Janssen, GlaxoSmithKline, Novartis, AbbVie, and Humanigen. She has also participated in conferences and consultancy activities for Aché, AstraZeneca, Chiesi, Eurofarma, IPI-ASAC, and Sanofi. Patricia Schonffeldt has served on speakers’ bureaus for AstraZeneca, GlaxoSmithKline, Teva Pharmaceuticals, ITF-Labomed, Boehringer Ingelheim, and Sanofi Genzyme. Walter Javier Mattarucco has served as a study investigator for AstraZeneca, GlaxoSmithKline, and Novartis. He has also served on speakers’ bureaus for AstraZeneca. Luis Fernando Tejado Gallegos is an employee of AstraZeneca. Maarten J.H.I. Beekman was an employee of AstraZeneca at the time this study was conducted.

Data availability statement

Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data sharing policy described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.

Additional information

Funding

AstraZeneca funded all the SABINA studies and was involved in designing the study, developing the study protocol, conducting the study, and performing the analyses. AstraZeneca was given the opportunity to review the manuscript before submission. AstraZeneca also funded medical writing support.