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Short-acting β2 -agonist use and asthma exacerbations in Swedish children: A SABINA Junior study
Erik Melén1,2, Bright I Nwaru3,4, Fredrik Wiklund5
1Department of Clinical Sciences and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Insights
High short-acting beta2-agonist (SABA) use in children with asthma is linked to increased exacerbation risk. This risk is higher in children without atopic diseases, highlighting the need for better asthma management strategies.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Public Health
Background:
- Short-acting beta2-agonist (SABA) overuse is a known risk factor for asthma exacerbations in adults.
- The association between SABA use and exacerbation risk in pediatric populations is not well-established.
- The SABINA Junior study investigated SABA use patterns in a general Swedish pediatric asthma cohort.
Purpose of the Study:
- To assess the association between short-acting beta2-agonist (SABA) collection and asthma exacerbation risk in children.
- To determine if this association differs based on age groups and comorbid atopic conditions.
- To inform clinical practice and public health initiatives for pediatric asthma management.
Main Methods:
- A population-based cohort study using Swedish national healthcare registries (2006-2015).
- Included children (<18 years) with asthma treated in secondary care.
- Negative binomial regression was used to analyze 1-year exacerbation risk based on SABA collection (0-2 vs. ≥3 canisters) and atopic status.
Main Results:
- High SABA use (≥3 canisters/year) was associated with increased asthma exacerbation risk across all pediatric age groups (0-5, 6-11, 12-17 years).
- Incidence rate ratios for increased risk ranged from 1.22 to 1.35.
- The association was more pronounced in children without comorbid atopic diseases (32%-44% increased risk) compared to those with atopic conditions (14%-21% increased risk).
Conclusions:
- High short-acting beta2-agonist (SABA) use is a significant indicator of increased asthma exacerbation risk in children.
- Children without comorbid atopic diseases appear to be at a higher risk when exhibiting high SABA use.
- Findings underscore the critical need for asthma medication reviews and educational interventions for caregivers and healthcare providers regarding SABA use in pediatric asthma.
Background:
In adults and adolescents with asthma, use of ≥3 short-acting β2 -agonist (SABA) canisters/year is associated with increased exacerbation risk. Whether this association is present in younger children remains unknown. In this SABA use IN Asthma (SABINA) Junior study, we assessed the association of SABA collection with exacerbation risk in the general Swedish pediatric asthma population.
Methods:
This population-based cohort study utilized linked data from the Swedish national healthcare registries involving patients with asthma (<18 years) treated in secondary care between 2006-2015. Exacerbation risk, by baseline SABA collection (0-2 vs. ≥3 canisters, further examined as ordinal/continuous variable) and stratified on comorbid atopic disease (allergic rhinitis, dermatitis and eczema, and food/other allergies), was assessed for 1-year follow-up using negative binomial regression.
Results:
Of 219,561 patients assessed, 45.4%, 31.7%, and 26.5% of patients aged 0-5, 6-11, and 12-17 years, respectively, collected ≥3 SABA canisters during the baseline year (high use). Collection of ≥3 SABA canisters (vs. 0-2) was associated with increased exacerbation risk during follow-up (incidence rate ratios [95% confidence interval]: 1.35 [1.29-1.42], 1.22 [1.15-1.29], and 1.26 [1.19-1.34] for 0-5-, 6-11-, and 12-17-year-olds, respectively); the association persisted with SABA as a continuous variable and was stronger among patients without atopic diseases (32%-44% increased risk versus. 14%-21% for those with atopic disease across groups).
Conclusions:
High SABA use was associated with increased asthma exacerbation risk in children, particularly in those without comorbid atopic diseases, emphasizing the need for asthma medication reviews and reformative initiatives by caregivers and healthcare providers on SABA use.
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