title: The use of β2-agonist therapy before hospital attendance for severe asthma exacerbations: a post-hoc analysis.
abstract: BACKGROUND
  Patterns of inhaled β2-agonist therapy use during severe asthma exacerbations before hospital attendance are poorly understood.
  
  
  OBJECTIVE
  To assess β2-agonist use prior to hospital attendance.
  
  
  METHODS
  We undertook an exploratory post hoc analysis of data from a 6-month clinical trial of 303 patients randomised to combination budesonide/formoterol inhaler according to a Single combination inhaler as Maintenance And Reliever Therapy regimen ('SMART') or fixed-dose budesonide/formoterol with salbutamol as reliever ('Standard'). Patterns of β2-agonist use for 14 days before hospital attendance with a severe asthma exacerbation were determined by electronic monitoring of inhaler use.
  
  
  RESULTS
  There were 22 hospital attendances in 16 patients during the study. Seven and nine hospital attendances were eligible for analysis in the SMART and Standard groups, respectively. In both regimens, β2-agonist use increased before hospital attendance, with a median (range) maximum daily number of actuations of 14 (9 to 63) budesonide/formoterol in SMART and 46 (6 to 95) salbutamol in Standard with 4 (0 to 10) budesonide/formoterol actuations on the day of maximal salbutamol use. There was delay in obtaining medical review despite high β2-agonist use, in 9/16 patients. Different patterns of use were observed, including repeated days of no inhaled corticosteroid despite marked salbutamol use, which occurred in 3/9 patients in the Standard group.
  
  
  CONCLUSIONS
  Delay in obtaining medical review in association with high β2-agonist use is common in patients before hospital presentation with severe exacerbations of asthma. The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations.
authors.affiliation: 1] Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK [2] Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
authors.affiliation: 1] Medical Research Institute of New Zealand, Wellington, New Zealand [2] Capital & Coast District Health Board, Wellington, New Zealand.
authors.forename: Janine
authors.initials: J
authors.lastname: Pilcher
authors.affiliation: 1] Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand [2] Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hancox
authors.affiliation: Papamoa Pines Medical Centre, Tauranga, New Zealand.
authors.forename: Davitt
authors.initials: D
authors.lastname: Sheahan
authors.affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand.
authors.forename: Alison
authors.initials: A
authors.lastname: Pritchard
authors.affiliation: 1] Medical Research Institute of New Zealand, Wellington, New Zealand [2] Capital & Coast District Health Board, Wellington, New Zealand.
authors.forename: Irene
authors.initials: I
authors.lastname: Braithwaite
authors.affiliation: Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK.
authors.forename: Dominick
authors.initials: D
authors.lastname: Shaw
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Black
authors.affiliation: 1] Capital & Coast District Health Board, Wellington, New Zealand [2] University of Otago, Wellington, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.affiliation: 1] Medical Research Institute of New Zealand, Wellington, New Zealand [2] Capital & Coast District Health Board, Wellington, New Zealand [3] University of Otago, Wellington, New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Beasley
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D019819:Budesonide / Q000008:administration & dosage*; D018450:Disease Progression; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D000068759:Formoterol Fumarate; D005938:Glucocorticoids / Q000008:administration & dosage*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D004983:Ethanolamines; D005938:Glucocorticoids; D019819:Budesonide; D000068759:Formoterol Fumarate