Short-acting β₂-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study

Abstract

BackgroundTo gain a global perspective on short-acting β2-agonist (SABA) prescriptions and associated asthma-related clinical outcomes in patients with asthma, we assessed primary health data across 24 countries in 5 continents.MethodsSABINA III was a cross-sectional study that employed electronic case report forms at a study visit (in primary or specialist care) to record prescribed medication(s), over-the-counter (OTC) SABA purchase, and clinical outcomes in asthma patients (≥12 years old) during the past 12 months. In patients with ≥1 SABA prescription, associations of SABA with asthma symptom control and severe exacerbations were analysed using multivariable regression models.ResultsOf 8351 patients recruited (n=6872, specialists; n=1440, primary care), 76.5% had moderate-to-severe asthma and 45.4% experienced ≥1 severe exacerbation in the past 12 months. Thirty-eight percent of patients were prescribed ≥3 SABA canisters; 18.0% purchased OTC SABA, of whom 76.8% also received SABA prescriptions. Prescriptions of 3–5, 6–9, 10–12 and ≥13 SABA (versus 1–2) were associated with increasingly lower odds of controlled or partly controlled asthma (odds ratio [95% CI]: 0.64 [0.53–0.78], 0.49 [0.39–0.61], 0.42 [0.34–0.51] and 0.33 [0.25–0.45], respectively; n=4597) and higher severe exacerbation rates (incidence rate ratio [95% CI]: 1.40 [1.24–1.58]; 1.52 [1.33–1.74]; 1.78 [1.57–2.02]; 1.92 [1.61–2.29], respectively; n=4612).ConclusionsThis study indicates an association between high SABA prescriptions and poor clinical outcomes across a broad range of countries, healthcare settings and asthma severities, providing support for initiatives to improve asthma morbidity by reducing SABA over-reliance.

Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations: SABINA Findings From Europe and North America

“…Finally, our findings are limited to specific countries in North America and Europe; however, further SABINA analyses evaluating the association of SABA exposure with multiple asthma outcomes in an additional 24 countries across 5 continents are now available. 48…”

An evaluation of short-acting β2-agonist prescriptions and associated clinical outcomes in asthma management in Indonesia – the SABINA Indonesia study

“…7 Use of ≥3 SABA canisters/year is considered undesirable since it indicates overreliance on SABA for the management of persistent symptoms, usually related to the underuse of ICS and other controllers. 18 We also analysed the SABA overprescriptions among asthma severity groups (Table 3). The SABA over-prescription in mild asthma patients was 17.9%, and 40% in the moderate-tosevere asthma group.…”

“…The anti-inflammatory reliever approach which contains combination of a rapidonset bronchodilator and ICS has been shown to be highly effective in mild asthma, where it may be used without maintenance dosing, and in moderate to severe asthma with fixed daily dosing of the same combination as maintenance treatment. 18 Low dose ICS/formoterol as reliever in mild asthma and on top of ICS/formoterol regular daily treatment in moderate and severe asthma has become the preferred approach in the GINA report. 19 Despite advances in disease understanding, asthma management guidelines and the availability of effective treatment, poor asthma control remains a major problem.…”

Environmental Sustainability in Respiratory Care: An Overview of the healthCARe-Based envirONmental Cost of Treatment (CARBON) Programme

“…A second set of studies will use SABA prescription/possession data from SABINA studies as well as inhaler sales data to evaluate emissions linked to SABA use versus all inhaler use, and that of SABA overuse in asthma. The analyses on SABA overuse will be conducted in patients (at least 12 years of age) as part of the SABINA studies [22,23,33] in Europe and Canada (SABA CARBON Europe-Canada), USA (SABA CARBON USA) and in other mostly lowand middle-income countries outside of Europe (SABA CARBON International).…”