Appropriateness of Bronchodilator Therapy and Its Association with Exacerbation and Hospitalization among Asthma Outpatients: A GINA 2024-Based Assesment
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Abstract
Bronchodilator use and inadequate therapy escalation may increase the risk of asthma exacerbations and hospitalization. This study evaluated treatment-related factors and its association with exacerbation and hospitalization among asthma outpatients. A retrospective cross-sectional study was conducted using medical records of asthma outpatients at RSUD Kota Kendari over a 1-year observation period (January–December 2024). A total of 94 eligible patients were included. Treatment-related factors comprising ICS–LABA therapy, inhalation route appropriateness, dosing appropriateness, therapy escalation with add-on LAMA, and SABA overuse were analyzed using bivariate analysis. ICS-LABA was associated with the lower risk of exacerbation (OR = 0.276; 95% CI: 0.104–0.735) and hospitalization (OR = 0.201; 95% CI: 0.072–0.559). Correct dosing was associated with lower risks of exacerbation (OR = 0.142; 95% CI: 0.052–0.390) and hospitalization (OR = 0.116; 95% CI: 0.039–0.343). Inhalation therapy showed a strong protective effect against exacerbation (OR = 0.078; 95% CI: 0.022–0.282) and hospitalization (OR = 0.059; 95% CI: 0.016–0.218). Lack of therapy escalation with add-on LAMA markedly increased the risk of exacerbation (OR = 17.889; 95% CI: 3.898–82.091) and hospitalization (OR = 14.000; 95% CI: 3.040–64.473). SABA overuse was strongly associated with higher likelihood of exacerbation (OR 10.833; 95% CI:2.987-39.288) and hospitalization (OR=14.167; 95% CI: 3.815-52.605). Asthma outcomes were mainly influenced by treatment-related factors. Optimizing inhaled controller therapy and applying stepwise treatment escalation according to GINA are essential to lower the risk of exacerbations and hospitalization.
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