Abstract
Background Prescription of ≥3 short-acting β2-agonist (SABA) canisters/year in adult and adolescent asthma populations is associated with a risk of severe exacerbations; however, evidence in children aged <12 years is limited.
Methods This study analysed data on children and adolescents with asthma in three age cohorts: 1‒5#, 6‒11#, and 12‒17# years from the Clinical Practice Research Datalink Aurum database for the period of 1/1/07-31/12/19. Associations between SABA prescriptions (≥3 versus <3 canisters/year) at baseline, defined as 6 months after an asthma diagnosis as a binary exposure variable, and the rate of future asthma exacerbations, defined as oral corticosteroid burst therapy, an emergency department visit, or hospital admission, were assessed by multilevel, negative binomial regression, adjusted for relevant demographic and clinical confounders.
Results Overall 48#,560, 110,091 and 111,891 paediatric patients with asthma were aged 1‒5#, 6‒11# years and 12‒17# years, respectively. During the baseline period, 22,423 (46.2#%), 42,137 (38.3#%) and 40,288 (36.0#%) in these three age cohorts were prescribed ≥3 SABA canisters/year, respectively. Across all age ranges, the rate of future asthma exacerbations in those prescribed ≥3 versus <3 SABA canisters/year was ≥2-fold higher. More than 30% of patients across all age cohorts were not prescribed inhaled corticosteroids (ICS) and the median proportion of days covered was only 33%, suggesting inadequate prescribing of ICS.
Conclusion In children, higher SABA prescriptions at baseline were associated with increased, future exacerbation rates. These findings highlight the need for monitoring prescription of ≥3 SABA canisters/year to identify children with asthma at risk of exacerbations.
Footnotes
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Conflict of interests: AM and CK have nothing to declare.
Conflict of interests: EM, TNT and RJPvdV are employees of AstraZeneca and hold AstraZeneca shares.
Conflict of interests: RJPvdV holds shares in GlaxoSmithKline. GR and IS received consultancy from AstraZeneca to their institutions for this work.
Conflict of interests: JKQ reports grants from AUK-BLF and The Health Foundation; grants and personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Bayer; and grants from Chiesi, outside the submitted work. JKQ's research group received funding from AstraZeneca for this work.
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- Received October 25, 2022.
- Accepted January 10, 2023.
- Copyright ©The authors 2023
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