SABINA: An international programme describing overuse of short-acting β2-agonists in asthma and related clinical outcomes

Aim: Asthma is a chronic, fluctuating, inflammatory disease. Short-acting β2-agonists (SABAs) do not address the underlying inflammation of asthma. However, SABAs are overused, often at the expense of inhaled corticosteroids, which treat the underlying inflammation. The SABa IN Asthma (SABINA) programme aims to describe the magnitude of SABA overuse globally and its impact on clinical asthma outcomes and healthcare utilisation.Methods: The SABINA programme1 comprises 34 retrospective or cross-sectional studies conducted across 3 pillars (Figure). Asthma patients aged ≥12 years are included. Using prescription data from electronic primary care medical records and/or healthcare databases (SABINA I/II) or electronic clinical report forms (SABINA III), SABA use during a 12-month period was described. SABA overuse was defined as prescription of ≥3 SABA canisters/year. As per data availability, multivariable regression analyses were performed to evaluate the association of SABA overuse with exacerbation risk and asthma-related healthcare utilisation. Here, we describe currently available results for Germany, Italy, Spain, Sweden and UK, with further data anticipated shortly. Results: SABA prescription data is currently available from 1.05 million patients across 5 countries2 (Figure). SABA overuse occurred in more than one-third of all asthma patients and across severities. In mild asthma, between 22–32% of patients overused SABA in all countries, except Italy (9%). In moderate-severe asthma, 13–31% of patients overused SABA, except in the UK (58%) and Italy (8%). In the UK and Sweden3, SABA overuse was associated with increased exacerbation risk across severities. Furthermore, in the UK, SABA overuse was associated with increased primary care and hospital consultations. Conclusion: Emerging findings from SABINA reveal that SABA overuse may be more common and associated with worse clinical outcomes, than initially perceived. We hypothesise that on-going analyses in the 29 remaining studies (countries) will report similar findings and provide further insight into global SABA overuse patterns. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The SABINA programme was designed and funded by AstraZeneca. References and Clinical Trial Registry Information Cabrera CS, et al. Eur Respir J. 2019 doi:10.1183/13993003.01858-2019. Janson C, et al (in press). Adv Ther. 2020. Nwaru BI, et al (in press). Eur Respir J. 2020 doi: 10.1183/13993003.01872-2019.