Overuse of short-acting beta-agonist bronchodilators in COPD during periods of clinical stability.
Overuse of short-acting beta-agonists (SABA) is described in asthma, but little is known about overuse of SABA in chronic obstructive pulmonary disease (COPD).



Prospective 3-month cohort study of patients with moderate-to-severe COPD who were provided a portable electronic inhaler sensor to monitor daily SABA use. Subjects wore a pedometer for 3 seven-day periods and were asked to complete a daily diary of symptoms and inhaler use. Overuse was defined as >8 actuations of their SABA per day while clinically stable.



Among 32 participants, 15 overused their SABA inhaler at least once (mean 8.6 ± 5.0 puffs/day), and 6 overused their inhaler more than 50% of monitored days. Compared to those with no overuse, overusers had greater dyspnea (modified Medical Research Council Dyspnea Scale: 2.7 vs. 1.9, p = 0.02), were more likely to use home oxygen (67% vs. 29%, p = 0.04), and were more likely to be on maximal inhaled therapy (long-acting beta-agonist, long-acting antimuscarinic agent, and an inhaled steroid: 40% vs. 6%, p = 0.03), and most had completed pulmonary rehabilitation (67% vs. 0%, p < 0.001). However, 27% of overusers of SABA were not on guideline-concordant COPD therapy.



Overuse of SABA was common and associated with increased disease severity and symptoms, even though overusers were on more COPD-related inhalers and more had completed pulmonary rehabilitation. More research is needed to understand factors associated with inhaler overuse and how to improve correct inhaler use.
VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA. Electronic address: vincent.fan@va.gov.
Vincent S
VS
Fan
VA Puget Sound Health Care System, Seattle, WA, USA.
Ina
I
Gylys-Colwell
VA Puget Sound Health Care System, Seattle, WA, USA.
Emily
E
Locke
Saint Louis VA Medical Center, St. Louis, MO, USA; Washington University School of Medicine, St. Louis, MO, USA.
Kaharu
K
Sumino
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Huong Q
HQ
Nguyen
VA Puget Sound Health Care System, Seattle, WA, USA.
Rachel M
RM
Thomas
Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
Sheryl
S
Magzamen
D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004417:Dyspnea / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D036501:Metered Dose Inhalers / Q000009:adverse effects / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D000067490:Prescription Drug Overuse / Q000009:adverse effects*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
Adherence; Adrenergic beta-2 receptor agonists; Medication; Metered dose inhaler; Pulmonary disease, chronic obstructive; Telemedicine