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Reliever salbutamol use predicts risk for COPD exacerbation

Short-term and long-term use of short-acting beta 2-agonist salbutamol 90 μg appeared associated with increased short- and long-term exacerbation of chronic obstructive pulmonary disease, according to study results.

“These data suggest that short-acting beta 2-agonist [SABA] use is an important and practical outcome for assessing both current control and future risk in patients with COPD,” Christine R. Jenkins, MD, MBBS, of the department of thoracic medicine in Concord Hospital at University of Sydney in Australia, and colleagues wrote. “Additional clinical trials and effectiveness studies of COPD patients with different disease severity and exacerbation history are needed to validate SABA use as a predictor of exacerbations in both clinical trials and in clinical practice.”

Jenkins and colleagues performed a retrospective analysis of reliever salbutamol 90 μg use in in 810 patients with moderate to very severe COPD. The patients were enrolled in a clinical trial designed to compare twice-daily budesonide/formoterol 320/9 μg and formoterol 9 μg.

Both groups of patients were provided reliever salbutamol 90 μg.

The investigators assessed first occurrence of reliever use as a predictor of short-term (3-week) exacerbation risk of COPD. Researchers categorized low reliever use as more than four inhalations per day, medium use as more than 10 inhalations per day and high use as more than 20 inhalations per day.

They also analyzed the long-term exacerbation risk within 3 months and 12 months of the study period using measures of inhalations per day, with low use defined as two to five uses, medium use defined as six to nine uses and high use defined as 10 or more uses.

In the short-term analysis, 692 patients reached the low threshold of reliever use, 351 patients reached the medium threshold and 91 patients reached the high threshold.

In the long-term analysis, 234 patients reached the low threshold of use, 155 patients reached the medium threshold and 92 patients reached the high threshold.

Patient results in the analysis were cumulative, meaning the patients who reached the highest threshold were also recorded as having reached the medium and low thresholds of reliever use as well.

Researchers reported a significant short-term exacerbation risk for patients with medium and high reliever use in the budesonide/formoterol group (P = .002) and the formoterol group (P < .0001) compared with the control group. Patients in the high reliever use group had a 135% increased exacerbation rate between months 3 and 12 of the study, compared with a 67% exacerbation rate in the medium use group and 21% in the low reliever use group.

In all reliever-use groups, patients taking budesonide/formoterol had lower short-term and long-term exacerbation rates, Jenkins and colleagues wrote. – by Jeff Craven

Disclosure: Jenkins reports advisory board roles with AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Merck Limited and Novartis, as well as consultant roles with AstraZeneca, Chiesi, GlaxoSmithKline and Pieris. Please see the full study for a list of all researchers’ relevant financial disclosures.