Patients with uncontrolled asthma, poor inhaled corticosteroid (ICS) compliance, comorbid allergic rhinitis, and occasionally patients without asthma frequently overuse over-the-counter short-acting beta agonists (SABAs), according to survey results published in BMJ Open.

Researchers conducted a community pharmacy-based survey in Australia that evaluated the clinical parameters, demographics, and behavioral characteristics of patients who overuse SABAs. The study included a total of 412 patients, 289 of whom were classified as overusers, defined as SABA use more than twice weekly in the previous 4 weeks. The primary outcomes were reliever use, patterns of ICS use, healthcare utilization, and asthma control, defined using the Global Initiative for Asthma (GINA).

After analysis, the researchers found that SABA overusers were more likely to have uncontrolled asthma (59.0% vs 15.4%; P <.001), moderate to severe nasal symptoms (80.8% vs 63.3%; P <.001), and have comorbid depression (11.1% vs 5.7%; P <.001) compared with non-overusers. Similar associations were observed in patients with suboptimal ICS adherence and some individuals without asthma.

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One key study limitation was the use of convenience sampling in patient recruitment.

“This is the first research to explore the real-life use of SABA in the community pharmacy, giving insights into individuals who overuse SABA medications and those who do not,” the researchers wrote.

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“Future research is needed to explore how the community pharmacist can better identify uncontrolled patients,” they concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Azzi EA, Kritikos V, Peters MJ, et al. Understanding reliever overuse in patients purchasing over-the-counter short-acting beta2 agonists: an Australian community pharmacy-based survey. BMJ Open. 2019;9(8):e028995.