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

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 (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). 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.