Overuse of short-acting beta-agonist bronchodilators in COPD during periods of clinical stability

Vincent S. Fan, Ina Gylys-Colwell, Emily Locke, Kaharu Sumino, Huong Q. Nguyen, Rachel M. Thomas, Sheryl Magzamen

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27 Scopus citations


Background Overuse of short-acting beta-agonists (SABA) is described in asthma, but little is known about overuse of SABA in chronic obstructive pulmonary disease (COPD). Methods Prospective 3-month cohort study of patients with moderate-to-severe COPD who were provided a portable electronic inhaler sensor to monitor daily SABA use. Subjects wore a pedometer for 3 seven-day periods and were asked to complete a daily diary of symptoms and inhaler use. Overuse was defined as >8 actuations of their SABA per day while clinically stable. Results Among 32 participants, 15 overused their SABA inhaler at least once (mean 8.6 ± 5.0 puffs/day), and 6 overused their inhaler more than 50% of monitored days. Compared to those with no overuse, overusers had greater dyspnea (modified Medical Research Council Dyspnea Scale: 2.7 vs. 1.9, p = 0.02), were more likely to use home oxygen (67% vs. 29%, p = 0.04), and were more likely to be on maximal inhaled therapy (long-acting beta-agonist, long-acting antimuscarinic agent, and an inhaled steroid: 40% vs. 6%, p = 0.03), and most had completed pulmonary rehabilitation (67% vs. 0%, p < 0.001). However, 27% of overusers of SABA were not on guideline-concordant COPD therapy. Conclusions Overuse of SABA was common and associated with increased disease severity and symptoms, even though overusers were on more COPD-related inhalers and more had completed pulmonary rehabilitation. More research is needed to understand factors associated with inhaler overuse and how to improve correct inhaler use.

Original languageEnglish
Pages (from-to)100-106
Number of pages7
JournalRespiratory Medicine
StatePublished - Jul 1 2016


  • Adherence
  • Adrenergic beta-2 receptor agonists
  • Medication
  • Metered dose inhaler
  • Pulmonary disease, chronic obstructive
  • Telemedicine


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