Countering the counter-productive: it’s time for an alternative to SABA-only asthma rescue treatment

13 Septemter 2021


Bradley E. Chipps, Past President of the American College of Allergy, Asthma & Immunology and Medical Director of Capital Allergy & Respiratory Disease Center in Sacramento, US

As time progresses, so does our understanding of how to optimise asthma care. Yet too often people with asthma are under-diagnosed1 and under-treated,2,3 with potentially serious consequences.4

Many patients with asthma use short-acting beta2-agonist (SABA) rescue inhalers to treat their disease. Though SABA provides fast symptom relief, it does not address the underlying inflammation that causes asthma attacks.5 Data from the largest real-world observational analysis of asthma inhaler therapy, SABA Use IN Asthma (SABINA),* showed that in Europe and North America, the incidence of severe exacerbations increased with increasing SABA canister prescription/possession, independent of maintenance therapy.6,7 There was a continuous association between prescription/possession of SABA and severe asthma exacerbations, demonstrating that careful monitoring of SABA use at any level can help identify at-risk patients.6

We must bring asthma management strategies in line with the latest science, addressing the underlying inflammation to optimise patient outcomes.

Significant unmet need among patients with asthma 

Asthma is a chronic, inflammatory disease that affects around 339 million people globally with an estimated 176 million asthma exacerbations per year.4,8 In the US alone, over 25 million patients are living with asthma,9 with more than 40% of these patients in the US experiencing one or more attacks a year.9 That amounts to over 10 million attacks per year.10

Beyond the emotional and physical cost, poorly managed asthma carries a hefty economic and societal burden. When accounting for the amount spent annually on asthma-related medical or indirect costs such as lost school and workdays, this puts a significant strain on not only the people living with this disease and their families, but also healthcare systems.10

Current management approaches can leave patients at risk of attacks

I often hear patients telling me how attached they feel to their SABA rescue inhaler, believing it is the best way to control their asthma. But SABA medication alone only addresses symptoms and regular use can mask disease progression and increase hyper-responsiveness in the airways, causing greater sensitivity to triggers.11 What’s more, a surprising 39% of patients see no need to take their preventative medicine12 (which is usually prescribed alongside their SABA inhaler) when they don’t feel unwell, thereby significantly underusing their maintenance inhaler.

Early reliance by patients on SABA is quickly established as it’s often the first medicine prescribed and because it provides immediate relief from the breathlessness symptoms they experience.5,13,14 This means that during symptom onset, many patients instinctively reach for their SABA inhaler.

Increasing SABA use can be a sign of poor asthma control and is associated with an increased risk of asthma attacks as the medicine does not treat the underlying inflammation, meaning patients may require oral corticosteroids (OCS).4,6,7,15 Results from the recent Annual Asthma Patient Surveyshowed that of 459 participants, across 5 countries, who had received OCS as an adult, 76% had received it for an asthma flare up in the previous two years.16 Even short-term treatment of exacerbations with OCS is associated with an increased risk of adverse health conditions, including type 2 diabetes, depression/anxiety, renal impairment, cataracts, cardiovascular disease, pneumonia and fracture.4,17,18

What needs to change in asthma management?

To reduce asthma attacks and potentially preventable deaths, global treatment and healthcare policies should provide clear guidelines for asthma management. Indeed, international recommendations from the Global Initiative for Asthma have been updated to no longer recommend SABA as the preferred rescue therapy.4

A combined approach focusing on inhaled combination medicines that provide symptom relief whilst also addressing underlying inflammation should be central to asthma management. This treatment intervention is especially important when asthma control is lost and symptoms increase, which could indicate the onset of a severe asthma attack. If such an approach were delivered early in the course of disease progression, patients would suffer fewer asthma attacks and live a life less burdened by their disease.

Strategies to achieve better outcomes for patients will also need to include education for healthcare providers around the risks of using SABA alone to manage this disease, given that even patients with mild asthma can have severe attacks.3


* The SABA Use IN Asthma (SABINA) programme is funded by AstraZeneca.

Online survey conducted by Ipsos on behalf of AstraZeneca and the Global Allergy and Airways Patient Platform (GAAPP). The survey was funded by AstraZeneca, with GAAPP providing counsel on the content. Fieldwork was completed between 21 February 2022 – 29 March 2022. Participants who chose to take part were included from the US (n=235), UK (n=108), Canada (n=54), Mexico (n=110), China (n=200) and Saudi Arabia (n=100). All participants are aged 18 years old or older, have been personally diagnosed with asthma by a healthcare professional (i.e., a doctor or nurse; NB doctor in France) and use an inhaler for their asthma. Those who used non-SABA inhalers were not eligible to take part in the study. No weighting has been applied to survey data. Quotas were set by type of inhalers used (SABA only, SABA + ICS, SABA + ICS LABA. For full details visit: []

1.     Kavanagh J, et al. Over-and under-diagnosis in asthma. Breathe. 2019; 15(1): e20-7.
2.      World Health Organization. Fact Sheet, Asthma. Available at: [Last accessed: 9 May 2022].
3.     Nolte H, et al. Unawareness and undertreatment of asthma and allergic rhinitis in a general population. Respir Med. 2006; 100(2): 354-62.
4.     Global Initiative for Asthma. 2021 GINA Report, Global Strategy for Asthma Management and Prevention. [Online]. Available at:  [Last accessed: 25 April 2022].
5.     O'Byrne PM, et al. The paradoxes of asthma management: time for a new approach? Eur Respir J. 2017; 50(3).
6.     Quint JK, et al.; on behalf of SABINA European and North American Study contributors. Short-acting β2-agonist exposure and severe asthma exacerbations: SABINA findings from Europe and North America. J Allergy Clin Immunol Pract 2022; DOI: Epub ahead of print.
7.      Bateman ED, et al. Eur Respir J 2021; Sep 24:2101402. doi: 10.1183/13993003.01402-2021. Epub ahead of print
8.     AstraZeneca Pharmaceuticals. Data on File: Annual Rate of Asthma Exacerbations Globally. (ID: SD-3010-ALL-0017).
9.     CDC. Most Recent National Asthma Data. [Online]. Available at: [Last accessed: 25 April 2022].
10.  The Global Asthma Network. The Global Asthma Report 2018. [Online]. Available at: [Last accessed: 25 April 2022].
11.  Beasley R, et al. The further paradoxes of asthma management: Time for a new approach across the spectrum of asthma severity. Eur Respir J. 2018; 52 :1800694
12.  Partridge MR, et al. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med. 2006; 6: 13.
13.  Reddel HK, et al. Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey. BMJ Open. 2017; 7 (9): e016688-e.
14.  Cole S, et al. ‘The blue one takes a battering’ why do young adults with asthma overuse bronchodilator inhalers? A qualitative study. BMJ Open. 2013; 3(2): e002247.
15.  Kaplan A, et al. Effective asthma management: is it time to let the AIR out of SABA? J Clin Med. 2020; 9(4): 921.
16.   AstraZeneca Data on file. 2022
17.  Price DB, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J Asthma Allergy. 2018; 11: 193–204.
18.   EPR-3: Expert panel report 3. Guidelines for the Diagnosis and Management of Asthma 2007 (EPR-3). [Online]. Available at: [Last accessed: 25 April 2022].

Veeva ID: Z4-43651

Date of preparation: May 2022