SABA Refills More Common in Moderate/Severe Persistent Asthma

woman using asthma inhaler
Woman using an inhaler for asthma
To better understand SABA usage and its implications, investigators examined prescription fulfillment patterns among patients with all levels of asthma severity.

Short-acting beta2-agonist (SABA) prescription fulfillment is greater in patients with moderate/severe persistent asthma vs those with intermittent/mild persistent asthma, although refill patterns are not uniform and are related to episodes of frequent rescue use after the initial fill in both groups. These were among research findings being presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held from October 16 to 19, 2022, in Nashville, Tennessee.

The frequency of SABA prescription fulfillment in asthma patients is thought to reflect the frequency of needed rescue therapy, which may in turn be an indicator of disease severity. To better understand SABA usage and its implications, investigators examined fill/refill patterns among patients with varying disease severity using data from the IBM MarketScan research database, which includes administrative claims data from 2010 to 2017.

The analysis included data from 546.898 US patients older than 12 years of age receiving SABA for asthma (mean [SD] age, 37.6 [18.7] years; 61.5% female; mean number of post index SABA fills, 3.2 [3.3]).  Of those, 323,443 (59.1%) patients had intermittent/mild persistent asthma and 223,455 (40.9%) had moderate/severe persistent asthma.

An index date was assigned to each participant based on a random SABA claim. Participants were required to have 12 months of continuous eligibility before and after the index date, an asthma diagnosis from pre-index to 60 days post-index, and at least 1 post-index maintenance or at least 1 additional SABA prescription fulfillment if no maintenance was used. The study authors assessed annual post-index SABA prescription fulfillment and refills during 30-day increments and compared the data between patients treated predominantly for intermittent/mild persistent vs moderate/severe persistent asthma.

Among the participants, 64.3% of all SABA fills post-index were refills, and 41.2% of all patients had at least 3 SABA fills. With respect to SABA refill timing, the investigators found that 21.6% occurred within 30 days of a previous fill; 42.8% occurred within 60 days of a previous fill; and 59.0% occurred within 90 days of a previous fill. These results indicate an average of at least 1 dose per day for each time interval.

In comparing patients treated with moderate/severe persistent asthma vs those treated with intermittent/mild persistent asthma, the researchers found those in the higher severity group had an increased mean number of SABA fills (4.1 [3.9] vs 2.7 [2.7], respectively), an increased proportion of fills that were refills (72.5% vs 58.6%, respectively), and an increased proportion of patients with at least 3 fills (53.9% vs 32.4%, respectively; all P <.001).

In addition, participants with moderate/severe persistent asthma had a greater proportion of all SABA refills within 30, 60, and 90 days of a previous claim compared with individuals with intermittent/mild persistent asthma (29.2% vs 16.3%, respectively, for 30 days; 57.3% vs 32.7%, respectively, for 60 days; and 78.7% vs 45.4%, respectively, for 90 days; all P <.001).

Many patients with asthma have annual SABA fills that are indicative of uncontrolled disease and increased incidence of exacerbations, noted the researchers. “Even 1 SABA canister refill in a year may be indicative of uncontrolled asthma,” stated the investigators. “As suggested by the Global Initiative for Asthma, a rescue therapy paradigm combining an inhaled corticosteroid with a fast-acting bronchodilator may better address the fluctuating nature of symptoms due to the variability of airway inflammation in asthma.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Lugogo NL, Pollack M, Gilbert I, Gandhi HN, Tkacz J, Lanz MJ. Patterns of short-acting beta2-agonist refills in US adults and adolescents with asthma across the disease severity spectrum. Abstract presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.