Excessive Short-acting Beta-agonists Prescriptions in COPD Treated with Triple Inhaler Therapy: A Possible Marker of Frequent Exacerbations. A Retrospective Cohort Study

OBJECTIVE: Short-acting β2-agonists (SABA) are used both in asthma and in chronic obstructive pulmonary disease (COPD); SABA use appears to be associated with an increased risk of exacerbations. We evaluated whether COPD patients receiving regular treatment with single-inhaler triple therapy (SITT) used SABA and whether they experienced more exacerbations. MATERIAL AND METHODS: Our single-center cohort study retrospectively included COPD patients who had been on SITT for 12 months and who were prescribed >7 inhaled corticosteroids/long-acting β2-agonists/long-acting muscarinic antagonist packages. Patients were divided into three groups based on the number of SABA boxes they received during the SITT year: no SABA (0 boxes/year), 1-2 boxes/year, and ≥3 boxes/year. Oral corticosteroids (OC) and antibiotic packs during the SITT year were considered outcomes for the SABA groups. RESULTS: < 0.0001]. CONCLUSION: A significant number of subjects were prescribed SABA despite SITT therapy. A relationship between SABA packages and the number of exacerbations, assessed by OC/antibiotic prescriptions, was observed. Excessive SABA use or prescription may indicate frequent exacerbations in patients with COPD despite receiving maximal inhaled therapy.