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Blue reliever inhaler overuse strongly linked with increased asthma attacks: Critical findings revealed in new study from Optimum Patient Care Australia

The new publication ‘The association between short-acting β2-agonist over-prescription, and patient-reported acquisition and use on asthma control and exacerbations: data from Australia’ to Advances in Therapy from OPCRDA (Optimum Patient Care Research Database Australia) delivers a wakeup call about the dangers of blue reliever inhaler (Short-Acting β2-Agonists, SABA) overuse in asthma. In this critical paper, data from 720 patients was utilised in a study design that combines both General Practice (GP) Medical Records and patient questionnaires. It examines the usage of blue reliever inhaler use, and relationship with asthma outcomes in Australia.

Major findings are uncovered:

  • Patients using three or more blue reliever inhalers had more than twice as many severe asthma attacks and four times more likely to have major asthma symptoms

  • This was even worse in those only buying reliever inhalers at a pharmacy, with 3 times more asthma attacks and almost 5 times more major asthma symptoms

Professor David B. Price, the lead author and Head of the Observational and Pragmatic Research Institute, emphasized, “Our study identifies a critical association between short acting beta agonist overuse and increased risks of adverse outcomes in asthma patients. In light of the magnitude of increased asthma attacks impacting patients, the findings must urge us to engage in careful consideration and monitoring of SABA use in the management of asthma." With availability of the inhalers over the counter being compounded by automated repeat release of prescriptions without medical review, easy access to blue reliever inhalers may be contributing to the concerning problem of their overuse.

‘‘The findings highlight opportunity to drive positive change in asthma care in Australia”, remarks Professor Christine Jenkins, second author of the study, Professor of Respiratory Medicine UNSW, and Head of Respiratory Group at the George Institute for Global Health, Australia. Professor Jenkins adds “The work calls for reformation of approaches to SABA use in asthma, through enhanced patient and clinician awareness of the impact of its overuse, and by addressing systems in place which may contribute to over acquisition”.

Dr Kerry Hancock, co-author of the study and General Practitioner in Australia, also shares “The study underscores the importance of implementing The Australian Asthma Handbook (AAH) recommendations: replacement of stand-alone SABA with regular low-dose inhaled corticosteroids (ICS) plus as needed SABA, or as needed ICS/formoterol [inhaled steroids with a long-acting beta agonist medication]1.

While blue reliever inhaler overuse is likely a symptom of poor asthma control rather than its cause, the results stress the importance of urgent medical review for patients affected, in addition to wider evaluation of access to inhalers without medical supervision.

To learn more about the study, please read the full publication in Advances in Therapy, as well as the accompanying slide deck.

This study was part of the SABA Use IN Asthma (SABINA) programme, an innovative framework of harmonised, large-scale observational studies across 40 countries, and was co-funded by AstraZeneca.

1. National Asthma Council. Australian Asthma Handbook Version 2.2 [Internet]. 13th ed. 2022, Available from:

About OPC

Optimum Patient Care (OPC) is a social enterprise that provides free clinically led quality improvement programmes into GP practices and respiratory specialists to take part in research. More information about OPC can be found at


Optimum Patient Care Research Database Australia (OPCRDA) has been purposefully designed to facilitate real-world data collection and address the growing demand for observational and pragmatic medical research, both within Australia and internationally.


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