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: Five thousand one hundred and seven subjects were recruited, and 1,444 (28.3%) had at least one SABA prescription. Adherence to SITT treatment was similar across the three SABA groups: 10.7±2.8, 10.6±2.8, and 10.9±3.9 packages/year in the 0, 1–2, and ≥3 SABA groups, respectively. The number of OC/antibiotic packages increased progressively across SABA groups from 0 to 1-2 and ≥3 (P < 0.0001). When we applied logistic models, we also observed a progressively higher risk of taking OC and antibiotics among subjects who had taken 1-2 packs of SABA [odds ratio (OR): 2.299 (1.878-2.813) and 2.034 (1.621-2.551), respectively; P < 0.0001], and among those who had taken ≥3 packs of SABA [OR: 3.472 (2.871-4.200) and 2.714 (2.192-3.362), respectively; P < 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.