Purpose: SABA overuse might indicate poorly managed or uncontrolled asthma and be responsible for poor health outcomes. The aim of this study integrated in new fourth multi-design SABINA+ pillar was to characterize the population using short-acting β₂-agonists for asthma and examine the patterns of its use among community pharmacy customers in Portugal, as well as identify characteristics associated with disease control and explore potential differences between GINA treatment steps.
Patients and Methods: This cross-sectional multicenter study was conducted in Portuguese community pharmacies between 29 May 2018 and 15 August 2018. Participants were adults (age ≥ 18 years) self-reporting asthma diagnosis recruited in the context of a short-acting β₂-agonist dispense. A two-part questionnaire (pharmacist interview and self-administered) was used to collect information about sociodemographic characteristics, comorbidities, reliever inhaler use, healthcare resource consumption and self-reported disease control (assessed by the Control of Allergic Rhinitis and Asthma Test – CARAT^®). Descriptive statistics was done to characterize the study sample. After categorizing patients according to GINA steps, based on their therapeutic regimen, we performed an exploratory subgroup analysis to evaluate if there were any differences between such groups in terms of the variables collected. A logistic regression was used to identify the potential determinants of overall disease control.
Results: Around 50.8% of patients were male, and the average age was 52 years old. Half of the patients never smoked, and 51.9% were employed. More than half of the patients report inhaler overreliance – purchasing more than 1 pack in 3 months (65.0%) or using the inhaler on more than 8 days over the previous 4 weeks (50.2%). Of the total number of patients in the study, 79.1% had poorly controlled asthma symptoms, and 78.7% had overall poorly controlled respiratory symptoms. We found statistically significant differences between GINA treatment steps in all sociodemographic characteristics (sex, mean age, education level, employment status); maximum number of SABA uses in 24h, CARAT score (total an asthma sub-score); history of exacerbations requiring ED visits or treatment with OCS for at least 3 days in the previous 12 months. Logistic regression revealed that patients reporting SABA use in more than 8 days in the previous 4 weeks and patients with at least 1 exacerbation requiring treatment with OCS for at least 3 days in the previous 12 months have greater odds of poor disease control [adjusted OR (95% CI): 2.6 (1.3– 5.2) and 3.0 (1.3– 6.6)].
Conclusion: Based on the results of this study, it can be inferred that the asthma population using SABA is largely uncontrolled and uses reliever inhalers excessively.

Keywords: chronic disease, short-acting beta-2 adrenergic agonist, overuse, exacerbations, CARAT^®


中文翻译：

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缓解吸入器使用者的特征和哮喘控制：葡萄牙社区药房的横断面多中心研究

目的： SABA 过度使用可能表明哮喘管理不善或不受控制，并导致健康结果不佳。这项纳入新的第四个多重设计 SABINA+ 支柱的研究的目的是描述使用短效 β2 激动剂治疗哮喘的人群的特征，并_检查葡萄牙社区药房客户的使用模式，并确定与疾病控制并探索 GINA 治疗步骤之间的潜在差异。
患者和方法：这项横断面多中心研究于2018年5月29日至2018年8月15日在葡萄牙社区药房进行。参与者是在短效β2的背景下招募的自我报告哮喘诊断的成年人（年龄≥18岁_） -激动剂分配。问卷由两部分组成（药剂师访谈和自我填写），用于收集有关社会人口学特征、合并症、缓解吸入器使用、医疗资源消耗和自我报告疾病控制的信息（通过过敏性鼻炎和哮喘控制测试 – CARAT 进行评估）^®）。进行描述性统计来表征研究样本。根据 GINA 步骤对患者进行分类后，根据他们的治疗方案，我们进行了探索性亚组分析，以评估这些组之间在收集的变量方面是否存在任何差异。使用逻辑回归来确定总体疾病控制的潜在决定因素。
结果：约50.8%的患者为男性，平均年龄52岁。一半的患者从不吸烟，51.9% 有工作。超过一半的患者报告吸入器过度依赖——在 3 个月内购买超过 1 包 (65.0%) 或在过去 4 周内使用吸入器超过 8 天 (50.2%)。在该研究的患者总数中，79.1%的患者哮喘症状控制不佳，78.7%的呼吸道症状总体控制不佳。我们发现 GINA 治疗步骤在所有社会人口特征（性别、平均年龄、教育水平、就业状况）方面存在统计学显着差异；24 小时内 SABA 最大使用次数、CARAT 评分（哮喘分项总分）；过去 12 个月内至少 3 天有需要急诊就诊或 OCS 治疗的病情加重史。Logistic 回归显示，报告在过去 4 周内使用 SABA 超过 8 天的患者以及在过去 12 个月内至少有 1 次恶化需要接受 OCS 治疗至少 3 天的患者疾病控制不佳的可能性更大 [调整后的 OR ( 95% CI)：2.6 (1.3–5.2) 和 3.0 (1.3–6.6)]。
结论：根据这项研究的结果，可以推断使用SABA的哮喘人群很大程度上不受控制，并且过度使用缓解吸入器。

关键词：慢性病、短效 β2 肾上腺素能激动剂、过度使用、病情加重、CARAT ^®