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Short-acting β-agonist use as a marker of current asthma control

Patel, Mitesh; Pilcher, Janine; Munro, Claire; Hosking, Alexander; Pritchard, Alison; Shaw, Dominick; Black, Peter; Weatherall, Mark; Beasley, Richard

Authors

Mitesh Patel

Janine Pilcher

Claire Munro

Alexander Hosking

Alison Pritchard

Dominick Shaw

Peter Black

Mark Weatherall

Richard Beasley



Abstract

Background

The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring.
Objective

To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment.
Methods

Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit.
Results

The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5.
Conclusion

Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control.

Journal Article Type Article
Journal Journal of Allergy and Clinical Immunology: In Practice
Electronic ISSN 2213-2201
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 1
Issue 4
Institution Citation Patel, M., Pilcher, J., Munro, C., Hosking, A., Pritchard, A., Shaw, D., …Beasley, R. (in press). Short-acting β-agonist use as a marker of current asthma control. Journal of Allergy and Clinical Immunology: In Practice, 1(4), doi:10.1016/j.jaip.2013.04.008
DOI https://doi.org/10.1016/j.jaip.2013.04.008
Keywords ACQ, Albuterol, Asthma, Control, Electronic, Metered-dose inhaler, Monitoring, Questionnaire, Reliever, Symptoms
Publisher URL http://www.sciencedirect.com/science/article/pii/S2213219813002122
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf


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