Volume 28, Issue 2 (9-2026)
yafte 2026, 28(2): 110-119 |
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Maghdoori A, Mohammad Nezhad G. Short-Acting β2-Agonists (SABA) Irrational Over-Utilization: Current State of Knowledge. yafte 2026; 28 (2) :110-119
URL: http://yafte.lums.ac.ir/article-1-3907-en.html
URL: http://yafte.lums.ac.ir/article-1-3907-en.html
Shahid Beheshti University of Medical Sciences, Faculty of Pharmacy, Tehran, Iran & Shahid Beheshti University of Medical Sciences, Faculty of Pharmacy, Tehran, Iran
Abstract: (4 Views)
Background: Despite current Global Initiative for Asthma (GINA) guidelines that discourage monotherapy with SABA, overuse of short-acting beta-2 agonists (SABA) continues. Overuse of SABA indicates poor control and may reduce therapeutic efficacy. This is especially true for metered dose inhalers (MDIs) that also contain significant amounts of hydrofluorocarbons.
Methods: A comprehensive review was conducted using predefined Boolean strings covering SABA overuse, asthma control, clinical outcomes, and environmental impact. Peer-reviewed original studies in people with asthma reporting SABA exposure and relevant outcomes were also included.
Results: Studies show that frequent exposure to SABA (≥3 inhalers per year) is associated with poor symptom control, increased reliance on reliever medications, symptom exacerbation, more emergency department visits, hospitalizations, and higher mortality risk. This excessive use is often due to low or delayed initiation of ICS. Similar patterns were observed in children, with a greater burden on education and care. Excessive SABA use is also linked to higher costs and significant CO₂ emissions. Evidence gaps include limited representation from low- and middle-income countries, potential bias in some studies, and the absence of comprehensive system-level evaluations.
Conclusion: SABA overuse is a robust marker of adverse asthma outcomes and avoidable environmental sequelae. Practice should align with GINA by minimizing SABA-only strategies, ensuring early ICS-containing therapy, implementing refill-based alerts and digital adherence tools, and educating patients to reframe “relief” as a warning sign.
Methods: A comprehensive review was conducted using predefined Boolean strings covering SABA overuse, asthma control, clinical outcomes, and environmental impact. Peer-reviewed original studies in people with asthma reporting SABA exposure and relevant outcomes were also included.
Results: Studies show that frequent exposure to SABA (≥3 inhalers per year) is associated with poor symptom control, increased reliance on reliever medications, symptom exacerbation, more emergency department visits, hospitalizations, and higher mortality risk. This excessive use is often due to low or delayed initiation of ICS. Similar patterns were observed in children, with a greater burden on education and care. Excessive SABA use is also linked to higher costs and significant CO₂ emissions. Evidence gaps include limited representation from low- and middle-income countries, potential bias in some studies, and the absence of comprehensive system-level evaluations.
Conclusion: SABA overuse is a robust marker of adverse asthma outcomes and avoidable environmental sequelae. Practice should align with GINA by minimizing SABA-only strategies, ensuring early ICS-containing therapy, implementing refill-based alerts and digital adherence tools, and educating patients to reframe “relief” as a warning sign.
Keywords: short-acting beta-2 agonist, asthma control, asthma exacerbations, overuse, patient awareness, environmental footprints
Type of Study: Review article / Policy brief |
Received: 2026/02/15 | Accepted: 2026/06/29 | Published: 2026/09/1
Received: 2026/02/15 | Accepted: 2026/06/29 | Published: 2026/09/1
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