New results from an observational data analysis of asthma inhaler therapy found that short-acting beta2-agonist (SABA) reliever overuse is a global issue adversely impacting asthma outcomes.1,2
Data from across the SABA Use IN Asthma (SABINA) global programme have been published in The Journal of Allergy and Clinical Immunology: In Practice (JACI: In Practice) and the European Respiratory Journal (ERJ).
The analysis
The multi-country analyses of over one million patients with asthma showed use of three or more SABA inhalers per year was associated with an increased risk of severe exacerbations1,2 and a lower likelihood of controlled asthma.2 The findings were consistent regardless of country and asthma severity, and the risk of exacerbation was independent of maintenance therapy containing inhaled corticosteroids (ICS), further highlighting the need for continued efforts to improve asthma management.1,2
SABINA data found that approximately 40% of patients across all asthma severities were prescribed or received three or more SABA inhalers per year.1 This was associated with a 32% increase in risk of severe asthma exacerbations compared to patients receiving one or two inhalers per year, independent of ICS-containing medications used.1
Official comments
Jennifer Quint, Professor of Respiratory Epidemiology at the National Heart and Lung Institute at Imperial College London, Honorary Consultant in Respiratory Medicine based at The Royal Brompton Hospital, London, UK and lead author of the JACI: In Practice publication, said: “As the largest analysis of clinical outcomes related to the use of reliever and maintenance therapies to date, the SABINA findings reveal that high use of SABA relievers is a common issue in many countries and is associated with a greater risk of severe asthma attacks in patients around the world. These data reinforce the urgent need to adopt treatment paradigms that improve asthma management, including those from the Global Initiative for Asthma, which no longer recommend SABA as the preferred reliever therapy across all asthma severities.”
Eric Bateman, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa and lead author of the ERJ publication, said: “The SABINA programme shows that the overuse of SABA is a global problem of considerable magnitude, associated with negative outcomes of asthma treatment. It brings into focus the need for renewed efforts to reduce over-reliance on SABAs and the adoption of treatment strategies that provide both quick symptom relief and an anti-inflammatory effect.”
Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca, said: “Results from SABINA across diverse patient populations and healthcare systems add to the body of evidence demonstrating SABA overuse is associated with an increased risk of exacerbations in patients with asthma. With more than 176 million asthma attacks experienced globally each year, there is a clear need for asthma management that addresses the inflammatory nature of the disease and reduces exacerbation risk to improve outcomes for patients.”
References
- Quint JK, et al.; on behalf of SABINA European and North American Study contributors. Short-acting β2-agonist exposure and severe asthma exacerbations: SABINA findings from Europe and North America. J Allergy Clin Immunol Pract 2022; DOI: https://doi.org/10.1016/j.jaip.2022.02.047. Epub ahead of print.
- Bateman ED, et al. Short-acting β2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J 2021; Sep 24:2101402. doi: 10.1183/13993003.01402-2021. Epub ahead of print. PMID: 34561293.
