Short-acting beta(2)-agonists and exacerbations in children with asthma in England: SABINA Junior: SABINA Junior
Short-acting beta(2)-agonists and exacerbations in children with asthma in England: SABINA Junior: SABINA Junior
Background Prescription of three or more short-acting β
2-agonist (SABA) canisters per 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 years, 6‒11 years and 12‒17 years from the Clinical Practice Research Datalink Aurum database for the period 1 January 2007 to 31 December 2019. Associations between SABA prescriptions (three or more versus fewer than three canisters per 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 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, respectively, were prescribed three or more SABA canisters per year. Across all age ranges, the rate of future asthma exacerbations in those prescribed three or more versus fewer than three SABA canisters per year was at least two-fold higher. >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 three or more SABA canisters per year to identify children with asthma at risk of exacerbations.
Morgan, Ann
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Maslova, Ekaterina
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Kallis, Constantinos
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Sinha, Ian
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Roberts, Graham
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Tran, Trung N.
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van der Valk, Ralf J.P.
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Quint, Jennifer K.
22800655-8987-4464-8385-7f08860c92f9
24 April 2023
Morgan, Ann
5d49d874-64ee-4108-8442-ec015b708a77
Maslova, Ekaterina
79c024e0-5f69-4df1-8221-8ccd1a36fb23
Kallis, Constantinos
64f6a65e-1d82-46c0-a63a-41ddc6f03853
Sinha, Ian
086e8f95-4b81-4998-b8fc-e8413b0d05d7
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Tran, Trung N.
c425f11b-e9b6-49c5-88e8-6356e1cc9db3
van der Valk, Ralf J.P.
dd0a7a93-634a-44b2-b8b8-5172530c0a8e
Quint, Jennifer K.
22800655-8987-4464-8385-7f08860c92f9
Morgan, Ann, Maslova, Ekaterina, Kallis, Constantinos, Sinha, Ian, Roberts, Graham, Tran, Trung N., van der Valk, Ralf J.P. and Quint, Jennifer K.
(2023)
Short-acting beta(2)-agonists and exacerbations in children with asthma in England: SABINA Junior: SABINA Junior.
ERJ Open Research, 9 (2), [00571-2022].
(doi:10.1183/23120541.00571-2022).
Abstract
Background Prescription of three or more short-acting β
2-agonist (SABA) canisters per 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 years, 6‒11 years and 12‒17 years from the Clinical Practice Research Datalink Aurum database for the period 1 January 2007 to 31 December 2019. Associations between SABA prescriptions (three or more versus fewer than three canisters per 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 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, respectively, were prescribed three or more SABA canisters per year. Across all age ranges, the rate of future asthma exacerbations in those prescribed three or more versus fewer than three SABA canisters per year was at least two-fold higher. >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 three or more SABA canisters per year to identify children with asthma at risk of exacerbations.
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Accepted/In Press date: 11 January 2023
e-pub ahead of print date: 24 April 2023
Published date: 24 April 2023
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Funding Information:
Support statement: This study was supported by AstraZeneca. AstraZeneca funded the SABINA studies and was involved in designing the programme, developing the study protocol, conducting the studies and performing the analyses. 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. Funding information for this article has been deposited with the Crossref Funder Registry.
Identifiers
Local EPrints ID: 477556
URI: http://eprints.soton.ac.uk/id/eprint/477556
ISSN: 2312-0541
PURE UUID: de384d96-9c5b-4ea9-afd9-32cc2def5ca7
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Date deposited: 08 Jun 2023 16:42
Last modified: 17 Mar 2024 03:02
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Contributors
Author:
Ann Morgan
Author:
Ekaterina Maslova
Author:
Constantinos Kallis
Author:
Ian Sinha
Author:
Trung N. Tran
Author:
Ralf J.P. van der Valk
Author:
Jennifer K. Quint
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