The impact of the overuse of short-acting β2-agonists on the risk of sepsis and septic shock

Chih-Cheng Lai; Chao-Hsien Chen; Ya-Hui Wang; Cheng-Yi Wang; Hao-Chien Wang

doi:10.1016/j.jaci.2021.11.029

The impact of the overuse of short-acting β2-agonists on the risk of sepsis and septic shock

J Allergy Clin Immunol. 2022 Jul;150(1):75-81.e1. doi: 10.1016/j.jaci.2021.11.029. Epub 2022 Jan 30.

Authors

Chih-Cheng Lai¹, Chao-Hsien Chen², Ya-Hui Wang³, Cheng-Yi Wang⁴, Hao-Chien Wang⁵

Affiliations

¹ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.
² Division of Pulmonary, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKey Medical College, New Taipei City, Taiwan.
³ Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
⁴ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. Electronic address: cywang@mospital.com.
⁵ Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: haochienwang@gmail.com.

PMID: 35108605
DOI: 10.1016/j.jaci.2021.11.029

Abstract

Background: Overuse of short-acting β-agonists (SABAs) could be associated with increased acute exacerbations and mortality in patients with asthma. However, the role of SABAs in sepsis has not been well studied.

Objectives: We sought to investigate the association between the overuse of SABAs and sepsis in patients with asthma.

Methods: Between 2001 and 2013, patients with asthma were identified from Taiwan asthma pay-for-performance program database, but patients with prior sepsis were excluded. The overuse of SABAs was defined as the use of 3 or more canisters annually.

Results: A total of 28,033 patients were found to have overused SABAs (overuse group), and 155,453 patients had acceptable use of SABAs (control group). Using propensity score matching method with 1:1 ratio, we had 2 subgroups with similar baseline characteristic and each group had 20,542 patients. The incidence of sepsis during the follow-up period was 1.26 per 100 person-years in the SABA overuse group, which was higher than in the control group (0.94 per 100 person-years). The crude and adjusted hazard ratios were 1.35 (95% CI, 1.26-1.44) and 1.33 (95% CI, 1.24-1.43), respectively. The SABA overuse group also had a higher risk of sepsis within 1 year than the control group (adjusted odds ratio, 1.34; 95% CI, 1.09-1.64). The incidence of septic shock during the follow-up period was 0.44 per 100 person-years in the SABA overuse group, which was higher than in the control group (0.33 per 100 person-years). The crude and adjusted hazard ratios were 1.32 (95% CI, 1.17-1.48) and 1.28 (95% CI, 1.14-1.44), respectively. Subgroup analysis consistently revealed a higher incidence of sepsis in the SABA overuse group than in the control group in all age and male groups before and after propensity score matching.

Conclusions: The overuse of SABA could be associated with an increased risk of sepsis and septic shock in the patient with asthma in Taiwan.

Keywords: Short-acting β-agonist; asthma; overuse; sepsis; septic shock.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Inhalation
Asthma* / drug therapy
Asthma* / epidemiology
Humans
Male
Reimbursement, Incentive
Sepsis* / epidemiology
Shock, Septic* / epidemiology
Taiwan / epidemiology