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

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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
Number of pages13
JournalEuropean Respiratory Journal
Issue number5
Early online date24 Sept 2021
Publication statusPublished - 5 May 2022

Bibliographical note

Data sharing
Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca’s data sharing policy described at

Editorial support was provided by Michelle Rebello, PhD, CMPP, of Cactus Life Sciences (part of Cactus Communications, Mumbai, India) in accordance with Good Publication Practice (GPP3) guidelines ( This support was fully funded by AstraZeneca.

Support statement
AstraZeneca funded the study; was involved in the study design, protocol development, study conduct and statistical analysis; and was given the opportunity to review the manuscript before submission. AstraZeneca also funded medical writing support. All authors had full access to all the data, wrote the report and accept responsibility for its publication.


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


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