High SABA Use Linked to Exacerbation Risk, More Healthcare Utilisation

Sarfaroj Khan 

August 05, 2020


  • High short-acting β2-agonist (SABA) inhaler use (≥3 canisters/year) is seen in over one-third of UK patients with asthma.

  • High SABA use is associated with a significant increase in exacerbations and healthcare utilisation, irrespective of asthma severity.

Why this matters

  • The Global Initiative for Asthma no longer recommends treatment with as-needed SABA alone for symptom relief in adolescents and adults.

  • Findings suggest that SABA prescription practices need to be aligned with current treatment recommendations.

Study design

  • As part of the SABINA (SABA use IN Asthma) programme, this study (SABINA I) included 574,913 patients with asthma (age, ≥12 years) using data from the UK Clinical Practice Research Datalink, 2007-2017.

  • The association between SABA inhaler use by British Thoracic Society (BTS) treatment steps (grouped as BTS steps 1/2 for mild asthma and steps 3-5 for moderate-to-severe asthma) and exacerbations was evaluated.

  • Funding: AstraZeneca.

Key results

  • Overall, 218,365 (38%) patients had high SABA inhaler use; 336,412 patients with asthma had linked hospital data; 222,135 (66%) received BTS steps 1/2 treatment and 114,277 (34%) received steps 3-5 treatment.

  • High SABA vs low SABA (0-2 canisters/year) inhaler users were at a significantly increased risk of:

    • exacerbations (BTS steps 1/2: adjusted HR [aHR], 1.20; 95% CI, 1.16-1.24; BTS steps 3-5: aHR, 1.24; 95% CI, 1.20-1.28).

    • asthma-related primary care consultations (BTS steps 1/2: adjusted incidence rate ratio [aIRR], 1.24; 95% CI, 1.23-1.26; BTS steps 3-5: aIRR, 1.13; 95% CI, 1.11- 1.15).

    • hospital outpatient consultations (BTS steps 1/2: aIRR, 1.19; 95% CI, 1.12-1.27; BTS steps 3-5: aIRR, 1.19; 95% CI, 1.13-1.26).


  • Retrospective design.

  • Overestimation of actual SABA inhaler use.


Bloom CI, Cabrera C, Arnetorp S, Coulton K, Nan C, van der Valk RJP, Quint JK. Asthma-Related Health Outcomes Associated with Short-Acting β2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program. Adv Ther. 2020 Jul 27 [Epub ahead of print]. doi: 10.1007/s12325-020-01444-5. PMID: 32720299 View abstract. 

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: