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Antila MA, Souza-Machado A, Gregório MG, Cruz ÁA, Angelini L, Beekman MJHI, Zonzin GA, Rabahi MF. Overprescription of short-acting β2 agonists: reflections from the SABINA study in Brazil. J Bras Pneumol 2024; 50:e20230174. [PMID: 38422337 PMCID: PMC11095926 DOI: 10.36416/1806-3756/e20230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. METHODS This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. RESULTS Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. CONCLUSIONS Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.
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Affiliation(s)
| | - Adelmir Souza-Machado
- . Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador (BA) Brasil
- . Fundação ProAR, Brasil
| | | | - Álvaro A Cruz
- . Fundação ProAR, Brasil
- . Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador (BA) Brasil
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Mendoza-Cano O, Murillo-Zamora E. Assessing the asthma-related burden of disease in Latin American and Caribbean countries: a sociodemographic perspective. Public Health 2024; 227:163-168. [PMID: 38232564 DOI: 10.1016/j.puhe.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE This study aimed to characterize the burden of asthma-related issues in Latin American and Caribbean countries from 1990 to 2019 and to assess their relationship with the sociodemographic index (SDI). STUDY DESIGN A cross-sectional analysis with an ecological approach was conducted. METHODS The disability-adjusted life years (DALYs) and the SDI data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Linear regression models were used to evaluate the relationship of interest. RESULTS During the study period, a total of 41.7 million DALYs were accounted, with the highest rates observed in children aged under 5 years (651, uncertainty interval [UI]: 369 to 1037 per 100,000) and females (342, UI: 241 to 471 per 100,000). In the multiple regression model based on data from 2019, a significant negative association was observed between the log-transformed DALY rates and the SDI. Specifically, for each unit increase in the SDI, asthma-related DALY rates decreased by an average of 0.97 % (95 % confidence interval: 0.48-1.00 %). CONCLUSIONS This study highlights heterogeneous age, gender, and country-related variations in asthma rates across Latin American and Caribbean countries and emphasizes the influence of sociodemographic factors on its burden.
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Affiliation(s)
- O Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, km. 9 Carretera Colima-Coquimatlán, Coquimatlán 28400, Mexico; Centro de Estudios e Investigación en Biocultura, Agroecología, Ambiente y Salud Colima, Ex-Hacienda Nogueras S/N, Nogueras 28450, Mexico.
| | - E Murillo-Zamora
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez 28984, Mexico.
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Montero-Arias F, Garcia JCH, Gallego MP, Antila MA, Schonffeldt P, Mattarucco WJ, Gallegos LFT, Beekman MJHI. Over-prescription of short-acting β 2-agonists is associated with poor asthma outcomes: results from the Latin American cohort of the SABINA III study. J Asthma 2023; 60:574-587. [PMID: 35670783 DOI: 10.1080/02770903.2022.2082305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Short-acting β2-agonist (SABA) over-reliance is associated with poor asthma outcomes. As part of the SABA Use IN Asthma (SABINA) III study, we assessed SABA prescriptions and clinical outcomes in patients from six Latin American countries. METHODS In this cross-sectional study, data on disease characteristics/asthma treatments were collected using electronic case report forms. Patients (aged ≥12 years) were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed the associations between SABA prescriptions and clinical outcomes. RESULTS Data from 1096 patients (mean age, 52.0 years) were analyzed. Most patients were female (70%), had moderate-to-severe asthma (79.4%), and were treated by specialists (87.6%). Asthma was partly controlled/uncontrolled in 61.5% of patients; 47.4% experienced ≥1 severe exacerbation in the previous 12 months. Overall, 39.8% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (considered over-prescription). SABA canisters were purchased over the counter (OTC) by 17.2% of patients, of whom 38.8% purchased ≥3 canisters in the 12 months prior. Of patients who purchased SABA OTC, 73.5% were prescribed ≥3 SABA canisters. Higher SABA prescriptions (vs. 1 - 2 canisters) were associated with an increased incidence rate of severe exacerbations (ranging from 1.31 to 3.08) and lower odds ratios of having at least partly controlled asthma (ranging from 0.63 to 0.15). CONCLUSIONS SABA over-prescription was common in Latin America, highlighting the need for urgent collaboration between healthcare providers and policymakers to align clinical practices with the latest evidence-based recommendations to address this public health concern.
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Affiliation(s)
- Felicia Montero-Arias
- Servicio de Neumología, Hospital México, CCSS y Hospital Clínica Bíblica Santa Ana, San José, Costa Rica
| | - Jose Carlos Herrera Garcia
- Pulmonary Function Unit, Unidad de Funcion Pulmonar, Unidad de investigación Clínica de Puebla, UISP Unidad de Investigación y Salud de Puebla, Puebla, Mexico
| | - Manuel Pacheco Gallego
- Neumología, Unversidad Tecnológica de Pereira Y Fundación Universitaria Visión de las Américas. Respiremos S.A.S-Clinical Comfamiliar, Pereira, Colombia
| | - Martti Anton Antila
- Clinical Research/Allergy, Clínica de Alergia Martti Antila, São Paulo, Brazil
| | - Patricia Schonffeldt
- Especialista Médicina Interna y Enfermedades Respiratorias, Instituto Nacional del Tórax ITMS Telemedicina de Chile, Santiago, Chile
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Cooper PJ, Figueiredo CA, Rodriguez A, Dos Santos LM, Ribeiro-Silva RC, Carneiro VL, Costa G, Magalhães T, Dos Santos de Jesus T, Rios R, da Silva HBF, Costa R, Chico ME, Vaca M, Alcantara-Neves N, Rodrigues LC, Cruz AA, Barreto ML. Understanding and controlling asthma in Latin America: A review of recent research informed by the SCAALA programme. Clin Transl Allergy 2023; 13:e12232. [PMID: 36973960 PMCID: PMC10041090 DOI: 10.1002/clt2.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/29/2023] Open
Abstract
Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non-atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non-atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource-poor settings where the disease burden is greatest.
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Affiliation(s)
- Philip J Cooper
- Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Camila A Figueiredo
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Gustavo Costa
- Center for Data Knowledge and Integration for Health (CIDACS), Fundação Oswaldo Cruz, Bahia, Salvador, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
| | - Thiago Magalhães
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Raimon Rios
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Ryan Costa
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Martha E Chico
- Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Esmeraldas, Ecuador
| | - Maritza Vaca
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Fundacion Ecuatoriana para la Investigacion en Salud (FEPIS), Esmeraldas, Ecuador
| | | | - Laura C Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Alvaro A Cruz
- Universidade Federal da Bahia and Fundação ProAR, Salvador, Brazil
| | - Mauricio L Barreto
- Center for Data Knowledge and Integration for Health (CIDACS), Fundação Oswaldo Cruz, Bahia, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Maspero J, Pavie J, Torres-Duque CA, Montero-Arias F, Cerino-Javier R, Rovira F, Beekman MJHI. Toward a better understanding of severe asthma phenotypes in Latin America: results from the PREPARE study. Curr Med Res Opin 2023; 39:627-638. [PMID: 36740960 DOI: 10.1080/03007995.2023.2174328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Data on severe asthma phenotypes in Latin America are lacking. The PREPARE study describes the prevalence of certain determinants of severe asthma among patients in 5 Latin American countries with blood eosinophil counts (BEC) ≥300 cells/mm3 and serum immunoglobulin E (IgE) concentrations >100 IU/mL. METHODS In this cross-sectional study, information on demographics, disease characteristics, and asthma treatments were extracted from the existing medical records of patients aged ≥12 years attending centers specialized in severe asthma management. Medical record data were transcribed onto electronic case report forms. Blood eosinophil counts and IgE concentrations were assayed from specimens obtained at study visit. Data were analyzed with descriptive statistics. RESULTS Data from 461 patients with severe asthma (mean age, 50.5 years) were analyzed. Most patients were female (73%), had a body mass index of ≥25 kg/m2 (77%), and received full healthcare reimbursement (63%). In the previous 12 months, 52% of patients experienced ≥1 severe exacerbation and 44% received oral corticosteroid burst therapy. Blood eosinophil counts ≥300 cells/mm3 and ≥150 cells/mm3 were reported in 44% and 76% of patients, respectively. In 58% of patients, serum IgE concentrations exceeded 100 IU/mL. Uncontrolled asthma was documented in 50% (n = 230) of patients. CONCLUSIONS The PREPARE study provides useful insights about the prevalence of eosinophilic and atopic phenotypes in patients with severe asthma in Latin America, thereby paving the way for a more personalized approach to managing severe asthma. Notwithstanding the treatment at specialized medical centers, disease burden remained high in this study population.
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Affiliation(s)
- Jorge Maspero
- Allergy and Respiratory Medicine, Fundación CIDEA, Buenos Aires, Argentina
| | - Juana Pavie
- Médico Broncopulmonar, Centro Respiratorio Integral, Quillota, Chile
| | - Carlos A Torres-Duque
- Fundación Neumológica Colombiana, CINEUMO, Research Department, Universidad de La Sabana, Bogotá, Colombia
| | | | - Ruth Cerino-Javier
- Consultorio de Especialidad Alergología Pediátrica, Hospital Angeles Villahermosa, Tabasco, México
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Pedrozo-Pupo JC, Pacheco Gallego MC, Baños Álvarez IDJ, Jaller Raad RA, Caballero Pinilla AC, Reynales Londoño H, Bernal Villada L, Beekman M. A Cross-Sectional Study on Prescription Patterns of Short-Acting β 2-Agonists in Patients with Asthma: Results from the SABINA III Colombia Cohort. J Asthma Allergy 2022; 15:1167-1178. [PMID: 36051434 PMCID: PMC9427209 DOI: 10.2147/jaa.s365009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/20/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Overuse of short-acting β2-agonists (SABAs) for asthma is associated with a significant increase in exacerbations and healthcare resource use. However, limited data exist on the extent of SABA overuse outside of Europe and North America. As part of the multi-country SABA use IN Asthma (SABINA) III study, we characterized SABA prescription patterns in Colombia. Patients and Methods This observational, cross-sectional cohort study of SABINA III included patients (aged ≥12 years) with asthma recruited from seven sites in Colombia. Demographics, disease characteristics (including investigator-defined asthma severity guided by the 2017 Global Initiative for Asthma report), and asthma treatments prescribed (including SABAs and inhaled corticosteroids [ICS]) in the 12 months preceding the study were recorded using electronic case report forms during a single study visit. Results Of 250 patients analyzed, 50.4%, 33.2%, and 16.4% were enrolled by pulmonologists, general medicine practitioners, and allergists, respectively. Most patients were female (74.0%) and had moderate-to-severe asthma (67.6%). Asthma was partly controlled or uncontrolled in 57.6% of patients, with 15.6% experiencing ≥1 severe exacerbation 12 months before the study visit. In total, 4.0% of patients were prescribed SABA monotherapy and 55.6%, SABA in addition to maintenance therapy. Overall, 39.2% of patients were prescribed ≥3 SABA canisters in the 12 months before the study visit; 25.2% were prescribed ≥10 canisters. Additionally, 17.6% of patients purchased SABAs over the counter, of whom 43.2% purchased ≥3 canisters. Maintenance medication in the form of ICS or ICS/long-acting β2-agonist fixed-dose combination was prescribed to 36.0% and 66.8% of patients, respectively. Conclusion Our findings suggest that prescription/purchase of ≥3 SABA canisters were common in Colombia, highlighting a public health concern. There is a need to improve asthma care by aligning clinical practices with the latest evidence-based treatment recommendations to improve asthma management across Colombia.
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Affiliation(s)
- John Carlos Pedrozo-Pupo
- PREVICARE LTDA. Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del Magdalena, Santa Marta, Colombia
| | - Manuel Conrado Pacheco Gallego
- División de Neumología y Endoscopia Respiratoria, Departamento de Medicina Interna, Universidad Tecnológica de Pereira, Universidad Visión de las Américas, RESPIREMOS Centro de Neumología y Endoscopia Respiratoria, Pereira, Colombia
| | | | - Rodolfo Antonio Jaller Raad
- Department of Allergy and Immunology, Centro de Investigación Médico Asistencial S.A.S, Barranquilla, Colombia
| | - Andrea Carolina Caballero Pinilla
- Centro de Investigación Clínica, Caja de Compensación Familiar CAFAM, Sede Centro de Atención en Salud CAFAM Floresta, Bogotá, Colombia
| | | | | | - Maarten Beekman
- Respiratory & Immunology AstraZeneca, The Hague, the Netherlands
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Bateman ED, Price DB, Wang HC, Schonffeldt P, Catanzariti A, van der Valk RJP, Beekman MJHI. Reply to: Cause or consequence? Eur Respir J 2022; 59:13993003.00103-2022. [PMID: 35210324 PMCID: PMC9178210 DOI: 10.1183/13993003.00103-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Eric D Bateman
- Emeritus Professor of Medicine, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore.,Primary Care Respiratory Medicine, Centre of Academic Primary Care, Division of Applied Sciences, University of Aberdeen, Aberdeen, UK
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Patricia Schonffeldt
- Especialista Medicina Interna y Enfermedades Respiratorias, Instituto Nacional del Tórax ITMS Telemedicina de Chile, Santiago, Chile
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Lai CC, Chen CH, Wang YH, Wang CY, Wang HC. The impact of the overuse of short-acting β2-agonists on the risk of sepsis and septic shock. J Allergy Clin Immunol 2022; 150:75-81.e1. [DOI: 10.1016/j.jaci.2021.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
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