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Original Research: Asthma |

Has Asthma Medication Use Caught Up With the Evidence?: A 12-Year Population-Based Study of Trends

Mohsen Sadatsafavi, MD, PhD; Hamid Tavakoli, MD; Larry Lynd, PhD; J. Mark FitzGerald, MD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by an arm’s length research contract with AstraZeneca Canada, mediated through and approved by the University-Industry Liaison Office at the University of British Columbia.

aCollaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada

bInstitute for Heart and Lung Health, Department of Medicine, University of British Columbia, Vancouver, Canada

cCentre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, Canada

dCentre for Health Evaluation and Outcomes Research, University of British Columbia, Vancouver, Canada

CORRESPONDENCE TO: Mohsen Sadatsafavi, MD, PhD, Room 4110, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC, Canada V6T1Z3


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(3):612-618. doi:10.1016/j.chest.2016.10.028
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Background  The importance of balance between controller and reliever medications in asthma is recognized. However, to our knowledge, the extent to which real-world practice has caught up with evidence-based guidelines has not been studied.

Methods  This was a retrospective cohort study of individuals 15 to 67 years of age who satisfied a validated case definition of asthma in the administrative health database of British Columbia, Canada between 2002 and 2013. Each patient-year was assessed for inappropriate and excessive prescription of short-acting beta-agonists (SABAs) and the balance between controller and reliever medications. Trends on three time axes were evaluated: calendar time, time course of asthma, and age. Poisson regression was used to test for a linear trend.

Results  Three hundred fifty-six thousand, one hundred twelve patients (56.5% female sex; mean age, 30.5 years) contributed 2.6 million patient-years. In 7.3% of the patient-years, SABAs were prescribed inappropriately. This proportion dropped by a relative rate of 5.3% per year (P < .001). In the first year of asthma, 6.3% of patients had indicators of inappropriate SABA use, which dropped within the first 3 years but increased thereafter. Excessive prescription of SABAs increased rapidly during the time course of asthma (change of 23.3% per year; P < .001) and by age (change of 5.1% per year; P < .001).

Conclusions  Despite overwhelming evidence regarding the risks, inappropriate prescription for SABAs was prevalent. Excessive SABA use might explain high asthma mortality in older patients. Inappropriate prescriptions declined over the study period but increased over the time course of asthma. These trends might have contributed to the declining asthma hospitalization rates in British Columbia, but there remain gaps in care and potential for improvement in asthma outcomes.

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