PT  - JOURNAL ARTICLE
AU  - Stephen G. Noorduyn
AU  - Christina Qian
AU  - Karissa M. Johnston
AU  - Mena Soliman
AU  - Manisha Talukdar
AU  - Brandie L. Walker
AU  - Paul Hernandez
AU  - Erika Penz
TI  - SABA use as an indicator for asthma exacerbation risk: an observational cohort study (SABINA Canada)
AID  - 10.1183/23120541.00140-2022
DP  - 2022 Jan 01
TA  - ERJ Open Research
PG  - 00140-2022
4099  - http://openres.ersjournals.com/content/early/2022/06/09/23120541.00140-2022.short
4100  - http://openres.ersjournals.com/content/early/2022/06/09/23120541.00140-2022.full
AB  - Background Patients with asthma use SABA to relieve symptoms but SABA alone does not treat underlying inflammation. Thus, overreliance on SABA may result in poor asthma control and negative health outcomes.Objective To describe use of SABA and characterise the relationship to severe exacerbations in the Canadian provinces of Nova Scotia (NS) and Alberta (AB).Methods In this longitudinal Canadian SABINA (SABA In Asthma) study, patients with an asthma diagnosis were identified between 2016–2020 within two provincial administrative datasets (Health Data Nova Scotia and Alberta Health Services). All patients were followed for ≥24 months, with the first 12 months used to measure baseline asthma severity. Medication use and the relationship of SABA overuse (≥3 canisters·year−1) with severe asthma exacerbations were characterised descriptively and via regression analysis.Results A total of 115,478 patients were identified (NS n=8034; AB n=107,444). SABA overuse was substantial across both provinces (NS: 39.4%; AB: 28.0%) and across all baseline disease severity categories. Patients in NS with SABA overuse had a mean (sd) annual rate of 0.46(1.11) exacerbations, compared to 0.30(1.36) for those with <3 canisters of SABA. AB had a mean (sd) rate of 0.31(0.86), and 0.17(0.62), respectively. Adjusted risk of severe exacerbation was associated with SABA overuse (NS IRR=1.36 [95% CI 1.18–1.56]; AB IRR=1.32 [95% CI 1.27–1.38]).Conclusion This study supports recent updates to CTS and GINA guidelines for asthma care. SABA overuse is associated with increased risk of severe exacerbations and can be used to identify patients at a higher risk for severe exacerbations.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: S.G. Noorduyn, M. Soliman, and M. Talukdar are employees of AstraZeneca Canada Inc. C. Qian and K. Johnston are employees of Broadstreet HEOR, which received funds from AstraZeneca Canada Inc. for this work. B.L. Walker has received advisory board and speaker's honoraria from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, and Sanofi, unrelated to this work. P. Hernandez received funding from AstraZeneca to his institution and company for data acquisition and covered costs to conduct study at local site. He has received grants paid to his institution from Canadian Institute of Health Research, Boehringer Ingelheim; Cyclomedica; Grifols; Vertex, and received speaker honoraria from AstraZeneca; Boehringer Ingelheim; Janssen. He received honoraria and participated in advisory boards from Acceleron; AstraZeneca; Boehringer Ingelheim; GSK; Janssen; Novartis; Sanofi; Takeda; Teva; Valeo. He volunteered at Canadian Thoracic Society as an executive committee and Board member unrelated to this work. E. Penz has received research funds paid to her institution from AstraZeneca and Saskatchewan Cancer Agency, CIHR, SHRF and Respiratory Research Centre paid to her institution unrelated to this work. She has received consulting fees from GlaxoSmithKline, AstraZeneca, and Sanofi Genzyme unrelated to this work. She received honoraria for participation on advisory boards, lecture series, educational events from AstraZeneca, GlaxoSmithKline, Sanofi, Boehringer Ingelheim, and International Centre for Evidence-Based Medicine (ICEBM), unrelated to this work. She is a Co-Chair COPD Assembly of Canadian Thoracic Society, Medical Lead at the Lung Cancer Screening Prevention Program, Saskatchewan Cancer Agency, and a Board Member, Institute for Cancer Research Advisory Board, Canadian Institute for Health Research.