Bruno SPOSATO, Leonardo Gianluca LACERENZA, Elisa PETRUCCI, Alberto RICCI, Alberto CRESTI, Pasquale BARATTA, Andrea SERAFINI, Claudio MICHELETTO, Maurizio DI TOMASSI, Antonio PERRELLA, Valerio ALONZI, Sara CROCE, Marco SCALESE
Thoracic Research and Practice - 2026;27(1):3-10
OBJECTIVE: Short-acting beta2-agonists (SABA) are used both in asthma and in chronic obstructive pulmonary disease (COPD); SABA use appears to be associated with an increased risk of exacerbations. We evaluated whether COPD patients receiving regular treatment with single-inhaler triple therapy (SITT) used SABA and whether they experienced more exacerbations. MATERIAL AND METHODS: Our single-center cohort study retrospectively included COPD patients who had been on SITT for 12 months and who were prescribed >7 inhaled corticosteroids/long-acting beta2-agonists/long-acting muscarinic antagonist packages. Patients were divided into three groups based on the number of SABA boxes they received during the SITT year: no SABA (0 boxes/year), 1-2 boxes/year, and >=3 boxes/year. Oral corticosteroids (OC) and antibiotic packs during the SITT year were considered outcomes for the SABA groups. RESULTS: Five thousand one hundred and seven subjects were recruited, and 1,444 (28.3%) had at least one SABA prescription. Adherence to SITT treatment was similar across the three SABA groups: 10.7+/-2.8, 10.6+/-2.8, and 10.9+/-3.9 packages/year in the 0, 1-2, and >=3 SABA groups, respectively. The number of OC/antibiotic packages increased progressively across SABA groups from 0 to 1-2 and >=3 (P < 0.0001). When we applied logistic models, we also observed a progressively higher risk of taking OC and antibiotics among subjects who had taken 1-2 packs of SABA [odds ratio (OR): 2.299 (1.878-2.813) and 2.034 (1.621-2.551), respectively; P < 0.0001], and among those who had taken >=3 packs of SABA [OR: 3.472 (2.871-4.200) and 2.714 (2.192-3.362), respectively; P < 0.0001]. CONCLUSION: A significant number of subjects were prescribed SABA despite SITT therapy. A relationship between SABA packages and the number of exacerbations, assessed by OC/antibiotic prescriptions, was observed. Excessive SABA use or prescription may indicate frequent exacerbations in patients with COPD despite receiving maximal inhaled therapy.
