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Clinical factors associated with the overuse of asthma rescue medication

Urrutia I1, Delgado J2, Domínguez-Ortega J3, Mascarós E4, Pérez M5, Resler G5, Plaza V6, on behalf on the MISTRAL Investigators Group.

1Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain.
2Allergy Department, Hospital Virgen Macarena, Sevilla, Spain.
3Department of Allergy, Healthcare Research Institute IdiPAZ, CIBER de Enfermedades Respiratorias, CIBERES, Hospital Universitario La Paz, Madrid, Spain.
4Medicina de Familia y Comunitaria, Centro de Salud Fuente de San Luis, Valencia, Spain, Spain.
5Medical Department AstraZeneca. Barcelona. Spain.
6Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain.

J Investig Allergol Clin Immunol 2020; Vol. 30(1)
doi: 10.18176/jiaci.0387

Abstract
Objective: Our aim was to evaluate the relationship between asthma clinical factors and use of relief medication.
Methods: This was an observational cross-sectional study conducted in Spain. The study recruited patients ≥ 12 years of age diagnosed with persistent asthma according to the GINA criteria and receiving maintenance treatment for at least 12 months. Use of relief medication was dichotomized: low use of rescue medication (LURM) (≤ twice/week) or high use of rescue medication (HURM) (≥ three times/week). A variety of clinical variables and patient reported outcomes (PROs) such as the Asthma Control Questionnaire-5 (ACQ-5) and Test of Adherence to Inhalers (TAI) were recorded.
Results: A total of 406 patients were recruited, mean (SD) age 44.3(17.9) years and 64% women. In 76.1% rescue medication was used ≤ twice/week. Bivariate analysis showed HURM was related to smoking habit, unscheduled emergency room visits, hospital admissions, increased inhaled corticosteroid doses, therapeutic upgrading and night awakenings in the last four weeks (p<0.001). The multivariate analysis showed a higher risk of using relief medication in smokers and former smokers, when the number of night awakenings increased, in cases of self-perception of partially controlled or uncontrolled asthma, or when asthma is uncontrolled according to ACQ-5.
Conclusions: Our study identifies the potential of using abuse of rescue medication in the last week as an alarm signal for disease parameters such as exacerbations, poor asthma control and disease severity.

Key words: relief medication, rescue medication, asthma control