RT Journal Article SR Electronic T1 Is Overreliance on SABA Associated with Health Risks in the Older Asthma Population? JF ERJ Open Research JO erjor FD European Respiratory Society SP 00032-2022 DO 10.1183/23120541.00032-2022 A1 Teresa To A1 Jingqin Zhu A1 Emilie Terebessy A1 Kimball Zhang A1 Andrea S Gershon A1 Christopher Licskai YR 2022 UL http://openres.ersjournals.com/content/early/2022/02/03/23120541.00032-2022.abstract AB Recent Global Initiative for Asthma (GINA) recommendations reduce the role of short-acting beta-agonist (SABA) premised on the associated exacerbation risk. The widely accepted SABA risk profile is based on limited data described 30 years ago. This GINA paradigm shift demands an examination of SABA risks in a modern therapeutic era. Recent studies confirm that SABA overuse is common and associated with adverse outcomes. This study aimed to determine associations between SABA use, all-cause mortality, and asthma exacerbations in an older North American asthma population.In this population-based cohort study, individuals with prevalent asthma (2006–2015) aged ≥65 years, eligible for provincial drug coverage, were included. Annual SABA canisters filled (0, 1–2, 3–5, ≥6) was the primary exposure. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox-Proportional Hazard regression, adjusted for confounders.There were 59 533 asthma individuals; 14% overused SABA (≥3 canisters annually). Compared to those who used <3 canisters, the adjusted HRs of death for those who used 3–5 and ≥6 canisters were 1.11 (95%CI: 1.02–1.22, p=0.0157) and 1.56 (95%CI: 1.41–1.71, p<0.0001), respectively. Severe asthma exacerbation rates for ≥3 and <3 canisters/year were 7.5% and 2.1%, respectively. The adjusted HRs of severe asthma exacerbations were 1.59 (95%CI: 1.40–1.82, p<0.0001) and 2.26 (95%CI: 1.96–2.60, p<0.0001) in those who used 3–5 and ≥6 SABA canisters per year, respectively.In Canada, 1/7 individuals with asthma overused SABA associated with an increased risk of severe asthma exacerbations and death. The adverse impacts of SABA overuse continue 30 years after early publications.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. To reports support for the present manuscript received from Ontario Ministry of Health to the Ontario Asthma Surveillance Information System allows us to access and process provincial administrative databases for this study.Conflict of interest: Dr. Licskai reports receiving grants or contracts from Novartis, Ontario Ministry of Health, Canadian Institutes of Health Research, Federal Economic Development Agency for Southern Ontario, Academic Medical Organization of Southwestern Ontario, AstraZeneca and Pfizer, outside the submitted work. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events received from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim and Novartis, outside the submitted work. Participation on a Data Safety Monitoring Board or Advisory Board for GlaxoSmithKline Ad Board Asthma Biologics, AstraZeneca Global Ad Board Asthma Biologics, Sanofi Genzyme Asthma Biologics Ad Board, Teva Canada Inhalation Ad Board, and Novartis Inhalation Asthma Ad Board, outside the submitted work. Unpaid leadership or fiduciary role in other board, society, committee or advocacy group, for Canadian Thoracic Society - Chair Asthma Assembly, Chair Canadian Respiratory Guidelines committee, and Asthma Research Group, outside the submitted work.Conflict of interest: Dr. Zhu has nothing to disclose.Conflict of interest: Dr. Terebessy has nothing to disclose.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Gershon has nothing to disclose.