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Abstract：
BACKGROUND: Excessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population.
METHODS: Retrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3-6, 7-10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma.
RESULTS: 17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3-6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7-10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37).
CONCLUSIONS: SABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.
METHODS: Retrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3-6, 7-10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma.
RESULTS: 17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3-6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7-10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37).
CONCLUSIONS: SABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.
摘要：
背景：在哮喘患者中过度使用短效β2激动剂（SABA）仍然是一个值得注意的问题，因为它与较高的死亡率有关。不能低估SABA在哮喘管理中的全球相关性，它对哮喘患者构成重大健康风险，并给医疗保健系统带来负担。这项研究,作为全球SABINA计划的一部分，旨在描述中国人群中与SABA使用相关的处方模式和临床结局。
方法：回顾性队列研究使用香港医院管理局（HA）的临床数据分析和报告系统（CDARS）的匿名电子医疗记录进行。纳入2011年至2018年间新诊断为哮喘且年龄≥12岁的患者，根据自哮喘诊断之日起的一年基线期内SABA使用情况(≤2、3-6、7-10或≥11个毒气罐/年)进行分层。从指数后一年到最早的事件审查对患者进行随访：结局发生和研究期结束（2020年12月31日）。Cox比例回归和负二项回归分别用于估计与SABA使用相关的死亡风险和住院频率。在调整了年龄之后，性别,Charlson合并症指数（CCI），和吸入皮质类固醇（ICS）剂量。结果包括所有原因，哮喘相关,与呼吸有关的死亡率，因任何原因入院的频率，以及因哮喘入院的频率。
结果：17,782名哮喘患者（平均年龄46.7岁，包括40.8％的男性），59.1％的患者过度使用SABA（每年≥3个罐）。每位患者的处方中位数为5.61SABA罐/年。与每年≤2个毒气罐的患者相比，基线期间过度使用SABA与更高的全因死亡风险相关。关联是剂量依赖性的，使用≥11罐/年(调整后风险比:1.42,95%CI:1.13,1.79)和3-6罐/年(调整后风险比:1.22,95%CI:1.00,1.50)的风险最高.较高的SABA处方量与住院频率增加相关，在7-10个罐/年的亚组中观察到最大风险（调整后的比率：4.81，95％CI：3.66，6.37）。
结论：在香港哮喘患者中，过度使用SABA是普遍存在的，并且与全因死亡风险和住院频率增加相关。
方法：回顾性队列研究使用香港医院管理局（HA）的临床数据分析和报告系统（CDARS）的匿名电子医疗记录进行。纳入2011年至2018年间新诊断为哮喘且年龄≥12岁的患者，根据自哮喘诊断之日起的一年基线期内SABA使用情况(≤2、3-6、7-10或≥11个毒气罐/年)进行分层。从指数后一年到最早的事件审查对患者进行随访：结局发生和研究期结束（2020年12月31日）。Cox比例回归和负二项回归分别用于估计与SABA使用相关的死亡风险和住院频率。在调整了年龄之后，性别,Charlson合并症指数（CCI），和吸入皮质类固醇（ICS）剂量。结果包括所有原因，哮喘相关,与呼吸有关的死亡率，因任何原因入院的频率，以及因哮喘入院的频率。
结果：17,782名哮喘患者（平均年龄46.7岁，包括40.8％的男性），59.1％的患者过度使用SABA（每年≥3个罐）。每位患者的处方中位数为5.61SABA罐/年。与每年≤2个毒气罐的患者相比，基线期间过度使用SABA与更高的全因死亡风险相关。关联是剂量依赖性的，使用≥11罐/年(调整后风险比:1.42,95%CI:1.13,1.79)和3-6罐/年(调整后风险比:1.22,95%CI:1.00,1.50)的风险最高.较高的SABA处方量与住院频率增加相关，在7-10个罐/年的亚组中观察到最大风险（调整后的比率：4.81，95％CI：3.66，6.37）。
结论：在香港哮喘患者中，过度使用SABA是普遍存在的，并且与全因死亡风险和住院频率增加相关。
