An assessment of short-acting β2-agonist (SABA) use and subsequent greenhouse gas (GHG) emissions in five European countries and the consequence of their potential overuse for asthma in the U.K.

Aim: Findings from the SABA use IN Asthma (SABINA) programme indicate that short-acting β2-agonist (SABA) overuse (≥3 canisters/year) is common across Europe1 and associated with poorer outcomes in patients with asthma2. The environmental impact of inhaler choice receives much attention, but is often focused on preventers only. We estimated the volume of SABA use and its greenhouse gas (GHG) emissions versus total inhaler use for the U.K. and other European countries. Annual volume and GHG emissions from SABA overuse in the U.K. were also calculated using SABINA U.K. data. Methods: Inhaler use was calculated using sales data (from IQVIA™) over 12 months to September 2019. Data were compared by dose, preventing confounding from inhaler actuation count differences. SABA overuse volume in asthma i.e. sum of ≥3 prescriptions in 12 months, was extracted from Clinical Practice Research Datalink GOLD as part of SABINA U.K. (≥12 years, any severity, 12-month period between 2007−2017). GHG emissions of inhalers were estimated using published and internal AstraZeneca data on their full life cycle. Results: SABA represents the majority of inhaler use and GHG emissions in the U.K. and its neighbours (Table). U.K. SABA use and GHG emissions per capita are approximately treble those of other countries. In SABINA U.K., 218,365 out of 574,913 asthma patients were potentially overusing SABA (x̄=6.51 prescriptions/year). Most (83%) asthma SABA prescriptions went to patients overusing SABA. For the U.K. asthma population, this represents 9.24 million SABA prescriptions and 250,000 tonnes of CO2 equivalent/year. Conclusion: These data demonstrate the GHG emissions associated with high SABA use across Europe and the U.K. Implementing guidelines to drive improvements in asthma care would improve asthma control, reduce reliever inhaler use and exacerbation frequency, benefiting patients and reducing carbon emissions. 1Janson C et al. Adv Ther. 2020;37:1124–1135.2Bloom CI et al. Adv Ther. 2020;37:4190−4208. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest The study was designed and funded by AstraZeneca. References and Clinical Trial Registry Information