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Clinical Factors Associated With Overuse of Asthma Reliever Medication

Urrutia I1, Delgado J2, Domínguez-Ortega J3, Mascarós E4, Pérez M5, Resler G5, Plaza V6, on behalf of 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) : 42-48
doi: 10.18176/jiaci.0387

Objective: Our aim was to evaluate the relationship between the clinical factors of asthma and the use of reliever medication.
Methods: We performed an observational cross-sectional study in Spain. The study population comprised patients aged ≥12 years diagnosed with persistent asthma according to the criteria of the Global Initiative for Asthma and receiving maintenance treatment for at least 12 months. Use of reliever medication was classified as low use of reliever medication (LURM) (≤2 times/wk) and high use of reliever medication (HURM) (≥3 times/wk). A variety of clinical variables and patient-reported outcomes (PROs) were recorded (eg, scores on the Asthma Control Questionnaire-5 [ACQ-5] and Test of Adherence to Inhalers [TAI]).
Results: A total of 406 patients were recruited. Mean (SD) age was 44.3 (17.9) years, and 64% were women. Reliever medication was used ≤2 times/wk in 76.1%. Bivariate analysis showed that HURM was related to smoking habit, unscheduled emergency department visits, hospital admissions, higher doses of inhaled corticosteroid, and night awakenings in the previous 4 weeks (P<.001). The multivariate analysis showed a higher risk of using reliever 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 the ACQ-5.
Conclusions: Our study identifies the potential of poor use of reliever medication in the last week as an alarm signal for disease-related parameters such as exacerbations, poor asthma control, and disease severity.

Key words: Reliever medication, Reliever medication, Asthma control