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Short-acting β2-agonist use and asthma exacerbations in Swedish children : A SABINA Junior study

Melén, Erik ; Nwaru, Bright I. ; Wiklund, Fredrik LU ; de Fine Licht, Sofie ; Telg, Gunilla ; Maslova, Ekaterina ; van der Valk, Ralf J.P. ; Tran, Trung N. ; Ekström, Magnus LU orcid and Janson, Christer (2022) In Pediatric Allergy and Immunology 33(11).
Abstract

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... (More)

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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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
asthma, children, exacerbations, pediatric, SABINA junior study, short-acting β-agonists, Sweden
in
Pediatric Allergy and Immunology
volume
33
issue
11
article number
e13885
publisher
Wiley-Blackwell
external identifiers
  • scopus:85142630472
  • pmid:36433853
ISSN
0905-6157
DOI
10.1111/pai.13885
language
English
LU publication?
yes
id
e5557362-531a-4cd1-be14-de72a46cad55
date added to LUP
2022-12-28 11:50:28
date last changed
2024-06-27 23:46:17
@article{e5557362-531a-4cd1-be14-de72a46cad55,
  abstract     = {{<p>Background: In adults and adolescents with asthma, use of ≥3 short-acting β<sub>2</sub>-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 (&lt;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.</p>}},
  author       = {{Melén, Erik and Nwaru, Bright I. and Wiklund, Fredrik and de Fine Licht, Sofie and Telg, Gunilla and Maslova, Ekaterina and van der Valk, Ralf J.P. and Tran, Trung N. and Ekström, Magnus and Janson, Christer}},
  issn         = {{0905-6157}},
  keywords     = {{asthma; children; exacerbations; pediatric; SABINA junior study; short-acting β-agonists; Sweden}},
  language     = {{eng}},
  number       = {{11}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Pediatric Allergy and Immunology}},
  title        = {{Short-acting β<sub>2</sub>-agonist use and asthma exacerbations in Swedish children : A SABINA Junior study}},
  url          = {{http://dx.doi.org/10.1111/pai.13885}},
  doi          = {{10.1111/pai.13885}},
  volume       = {{33}},
  year         = {{2022}},
}