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

Njira Lugogo,1 Rena C Moon,2 Yen Chung,3 Joy David,2 Omar Motawakel,3 Ning A Rosenthal,2 Neil Skolnik4 1Pulmonary & Critical Care Medicine, University of Michigan Health, Ann Arbor, MI, USA; 2Premier Applied Sciences, Premier Inc, Charlotte, NC, USA; 3BPM-US, AstraZeneca, Wilmington, DE, USA; 4Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USACorrespondence: Rena C Moon, Premier Applied Sciences, Premier Inc., 13520 Ballantyne Corporate Place, Charlotte, NC, 28277, USA, Tel +1-704-816-3858, Email rena_moon@premierinc.comPurpose: We aimed to describe the disease burden of asthma and examine relationships between short-acting beta-2 agonist (SABA) use and asthma exacerbations.Patients and Methods: 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.Results: 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.Conclusion: 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.Plain Language Summary: Inappropriate use of short-acting beta-2 agonist (SABA) among patients with mild asthma is associated with increased risk of progressing to more severe disease. The results of this study show that patients with uncontrolled asthma (ie, greater use of SABA rescue inhaler) experienced higher rates of exacerbations, despite having greater use of maintenance therapy, underscoring the importance of new rescue therapy approaches to decrease the burden of asthma exacerbation among patients with high SABA-only rescue inhaler use.Keywords: asthma, burden, SABA inhaler, albuterol, rescue therapy