Evaluation of short-acting Beta-2-agonist prescriptions and associated clinical outcomes: Findings from the SABA use IN Asthma (SABINA) study in Asia

Abstract

Background: The extent of short-acting Beta-2-agonist (β₂-agonist) (SABA) use across Asian countries is not well documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions and clinical outcomes in patients with asthma from Asia.

Methods: This cross-sectional study recruited patients (aged ≥12 years) with asthma from 8 Asian countries. Data on disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by practice type (primary or specialist care) and investigator-defined asthma severity (per Global Initiative for Asthma [GINA] 2017 recommendations). The association of SABA prescriptions with clinical outcomes was analyzed using multivariable regression models.

Results: Overall, 3066 patients were analyzed, with a mean (standard deviation) age of 51.8 (16.7) years; of these patients, 2116 (69%) were female, 2517 (82.1%) had moderate-to-severe asthma and 2498 (81.5%) and 559 (18.2%) were treated in specialist and primary care, respectively. In total, 1423 (46.4%) patients had partly controlled/uncontrolled asthma, with 1149 (37.5%) patients experiencing ≥1 severe asthma exacerbation in the previous year. Overall, 800 (26.7%) patients were prescribed ≥3 SABA canisters in the previous year, which is regarded as overprescription and was associated with a significantly decreased odds of at least partly controlled asthma and increased incidence rates of severe exacerbations (P < 0.01 for both associations).

Conclusion: The findings from this cohort of predominantly specialist-treated patients with asthma indicate SABA overprescription in at least 1 in every 4 patients, and this overprescription is associated with poor clinical outcomes. These data highlight the need for adherence to recently updated asthma treatment recommendations in Asia.

Keywords: Adrenergic beta-2 receptor agonists; Asia; Asthma; Prescriptions; Public health.

Fig. 1

Patient disposition and study population by practice type and investigator-classified asthma severity

Fig. 2

Patient enrollment across countries in the SABINA III Asian cohort

Fig. 3

SABA prescriptions according to investigator-classified asthma severity and practice type. SABA, short-acting β₂-agonist

Fig. 4

Association of SABA prescriptions with (A) severe exacerbations and (B) level of asthma symptom control. BMI, body mass index; CI, confidence interval; GINA, Global Initiative for Asthma; IRR, incidence rate ratio; OR, odds ratio; SABA, short-acting β₂-agonist