Short-acting β₂-agonists and exacerbations in children with asthma in England: SABINA Junior

Abstract

BackgroundPrescription 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.MethodsThis 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 (≥3versus<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.ResultsOverall 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 ≥3versus<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.ConclusionIn 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.

Recent trends in asthma diagnosis, preschool wheeze diagnosis and asthma exacerbations in English children and adolescents: a SABINA Jr study

“…Our study also did not evaluate the association between trends in influenza or pneumococcal vaccinations and prescribing patterns of asthma medications. However, neither coverage for the influenza or pneumococcal vaccinations 23 24 nor asthma prescribing patterns 25 substantially varied during the 10-year study period; therefore, this is unlikely to have impacted our study findings. We are aware that there are difficulties in estimating prevalence slopes using aggregate-level data, particularly where there are repeated measures from some patients in different years.…”

Development of an Asthma Exacerbation Risk Prediction Model for Conversational Use by Adults in England

“…We also included a categorical predictor corresponding to GINA steps (1–5) criteria that are used to select initial controller treatment in adults and adolescents with a diagnosis of asthma. We combined these categories related to asthma control level based on Global Initiative for Asthma (GINA) steps based on GINA 2020 guidelines 18 with a category that corresponded to patients with SABA only prescriptions (following 5 ). Finally, we added a category for patients with no medications related to asthma during the last 12 months and GP review for asthma in the last 12 months.…”

“…More specifically, disease codes for asthma exacerbations recorded in primary care were used in combination with secondary care codes corresponding to either hospitalisation, A&E admission or use of systemic steroids. Whilst the gold standard definition of an asthma exacerbation includes worsening of symptoms, 5 this is not something that we could routinely capture in the data and so we used a definition that has been used in these data multiple times previously. [19][20][21][22][23]…”

“…People who have exacerbations are at risk of having further exacerbations. 4 Asthma exacerbations were defined as worsening of symptoms, 5 which required a short course of oral corticosteroids (OCS), an A&E visit, or a hospitalisation. However, whether there are specific factors that affect the likelihood of having an exacerbation of asthma and how this may differ from one individual to the next has not been fully investigated.…”