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

Eric D Bateman* (Corresponding Author), David Price, Hao-Chien Wang, Adel Khattab, Patricia Schonffeldt, Angelina Catanzariti, Ralf J.P. van der Valk, Maarten J.H.I. Beekman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: To 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.
Methods: SABINA 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.
Results: Of 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 (vs 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).
Conclusions: This 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.
Original languageEnglish
JournalEuropean Respiratory Journal
Publication statusAccepted/In press - 8 Sep 2021

Keywords

  • asthma
  • global
  • public health
  • prescription
  • short acting β2-agonist

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