Disease Burden of Asthma Patients Utilizing Short-Acting Beta-2 Agonist-Only Inhalers as Rescue in the United States

We aimed to describe the disease burden of asthma and examine relationships between short-acting beta-2 agonist (SABA) use and asthma exacerbations.

This retrospective cohort study used geographically diverse Premier Healthcare Database (PHD) and linked insurance claims (10/01/2021-09/30/2022) for US patients aged ≥18 years with a SABA-only prescription and a history of asthma exacerbation within 12 months before index date (the earliest SABA prescription date). Three asthma control groups were defined based on SABA usage: well controlled-low (0-1 prescriptions), not well controlled-medium (2-3 prescriptions), very poorly controlled-high (≥4 prescriptions). Four asthma severity groups were defined using asthma medication usage: intermittent, mild persistent, moderate persistent, and severe persistent.

A total of 12,692 patients were included: mean age 38.7 years, 73% female, 54% white, 31% Black, and 70% Medicaid patients. During the 12-month post-index period, 31% (n = 3,889) experienced an exacerbation at a mean rate 0.51 (SD 1.05) per patient. The percentage of patients with low, medium, and high SABA-only prescriptions were 42%, 21%, and 37%, respectively. A greater proportion of high-SABA users had an asthma exacerbation (41%) versus medium- (32%) or low- (20%) SABA users (both p < 0.0001). The proportion of patients with asthma maintenance controller use was the highest (71%) among high-SABA users, followed by medium- (56%), and low- (35%) SABA users (all p < 0.0001). Mean rates of asthma exacerbation during 12-month post-index period were 0.34 (SD 0.75) in the intermittent, 0.43 (SD 0.87) in the mild persistent, 0.43 (SD 0.82) in the moderate persistent, and 0.73 (SD 1.37) in the severe persistent groups (p < 0.0001). Almost a quarter (24%) of patients with intermittent asthma experienced an exacerbation during this period.

Patients with greater use of SABA-only rescue inhalers experienced higher rates of exacerbations, despite having greater asthma controller use. New rescue therapy approaches are needed to decrease the burden of illness in asthma patients.