Over-prescription of short-acting β2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINAIII study

Background: The extent of short-acting beta(2)-agonist (SABA) overuse in Africa remains poorly documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions/clinical outcomes in 3 African countries. Methods: Data on disease characteristics/asthma treatments were collected from patients (>= 12 years) using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed associations between SABA prescriptions and outcomes. Results: Data from 1778 patients (mean age, 43.7years) were analyzed. Most patients were female (62.4%) and had moderate-to-severe asthma (63.3%), with 57.1 and 42.9% of patients treated in specialist and primary care, respectively. Asthma was partly controlled/uncontrolled in 66.2% of patients, with 57.9% experiencing >= 1 severe exacerbation in the previous 12 months. Overall, 46.5% of patients were prescribed >= 3 SABA canisters in the preceding 12 months (over-prescription); 26.2% were prescribed >= 10 canisters. SABAs were purchased over-the-counter by 32.6% of patients, of whom 79.3% had received SABA prescriptions; 71.9% and 40.1% for >= 3 and >= 10 canisters, respectively. Higher SABA prescriptions (vs. 1-2 canisters) were associated with increased incidence rate of severe exacerbations and lower odds of having at least partly controlled asthma (except 3-5 canisters). Conclusions: Findings from this African cohort of the SABINA III study indicate that SABA overprescription and SABA over-the-counter purchase are common and associated with poor asthmarelated outcomes. This highlights the need for healthcare providers/policymakers to align clinical practices with the latest treatment recommendations.