title: Relationship between recent short-acting beta-agonist use and subsequent asthma exacerbations.
abstract: BACKGROUND
  US national guidelines recommend assessing short-acting beta-agonist (SABA) medication use as a marker of asthma severity and control. However, the relationship between recent SABA use and asthma exacerbations is not currently known.
  
  
  OBJECTIVE
  To evaluate the proximal relationship between the type and frequency of SABA use and asthma-related outcomes.
  
  
  METHODS
  We evaluated SABA use among patients with asthma ages 5 to 56 years who were members of a large health maintenance organization in southeast Michigan. Frequency of use was estimated from pharmacy data assessing the timing and amount of SABA fills. Cox proportional hazards models were used to examine the prospective relationship between average daily SABA use for 3 months and outcomes associated with poor asthma control (ie, oral corticosteroids use, asthma-related emergency department visits, and asthma-related hospitalizations). We separately accounted for SABA metered-dose inhaler (MDI) and SABA nebulizer use.
  
  
  RESULTS
  Of the 2,056 patients who met study criteria, 1,569 (76.3%) had used a SABA medication in their baseline year. After adjusting for potential confounders, SABA nebulizer use was associated with asthma-related emergency department visits (adjusted hazard ratio [aHR], 6.32; 95% confidence interval [CI], 2.38 to 16.80) and asthma-related hospitalizations (aHR, 21.62; 95% CI, 3.17 to 147.57). In contrast, frequency of SABA MDI use was not associated with these outcomes.
  
  
  CONCLUSIONS
  Frequency of SABA use during a 3-month period was associated with poor asthma outcomes. The relationship with poor asthma outcomes was strongest for SABA nebulizer use, suggesting that the type of SABA used is also of prognostic importance.
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Paris
authors.forename: Edward L
authors.initials: EL
authors.lastname: Peterson
authors.forename: Karen
authors.initials: K
authors.lastname: Wells
authors.forename: Manel
authors.initials: M
authors.lastname: Pladevall
authors.forename: Esteban G
authors.initials: EG
authors.lastname: Burchard
authors.forename: Shweta
authors.initials: S
authors.lastname: Choudhry
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
authors.forename: L Keoki
authors.initials: LK
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents