An evaluation of short-acting β2-agonist prescriptions and associated clinical outcomes in asthma management in Indonesia – the SABINA Indonesia study

Wiwien Heru Wiyono, Muhammad Amin, Susanthy Djajalaksana, Amira Permatasari Tarigan, Febrina Susanti, Hisham Farouk, Helyanna Helyanna


Background: Asthma is a chronic inflammatory disease, therefore inhaled corticosteroid (ICS) should be as the cornerstone of asthma treatment. However patients tend to rely on short-acting β2-agonist (SABA) due to immediate symptom relief and underuse ICS, thereby undertreating the underlying inflammation. As part of the multi-country SABA use IN Asthma (SABINA) III study, we aimed to describe SABA prescription patterns and asthma-related clinical outcome in Indonesia.

Methods: Cross-sectional study in asthma patients (> 12 years old) during August 2019 –  January 2020. Disease characteristic, prescribed asthma treatment in the 12 months before the study visit, and clinical outcomes, were recorded during a single visit and entered into an electronic case report form.

Results: Of 219 patients recruited, the mean number of SABA canisters prescribed was 4 canisters per year. SABA over-prescription (≥ 3 canisters/year) seen in 37% patients, and was greater in moderate-to-severe vs mild asthma (40% vs 17.9%). 47.5% of patients had at least 1 severe exacerbation; and 7.3% of patients had ≥3 severe exacerbations, in the past 12 months. Almost half of the patients (40.2%) were prescribed oral corticosteroids (OCS). Overall, the well-, partly, and uncontrolled patients were 41.6%, 37.4%, and 21%, respectively.

Conclusion: SABA over-prescription occurs in approximately one third of asthma patients, especially among moderate-to-severe patients and almost half of asthma patients experienced at least 1 severe exacerbation in the previous year. This highlights a public health concern and the need to improve asthma care by aligning with global recommendations including reducing SABA over-reliance in Indonesia


asthma; SABA; over-prescription; exacerbation

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Asthma GIf. Pocket Guide for Asthma Management and Prevention 2019. Available from:

Stallberg B, Lisspers K, Hasselgren M, Janson C, Johansson G, Svardsudd K. Asthma control in primary care in Sweden: a comparison between 2001 and 2005. Primary care respiratory journal : journal of the General Practice Airways Group. 2009;18(4):279-86.

Network GA. The Global Asthma Report 20182018. Available from:

Barnes CB, Ulrik CS. Asthma and adherence to inhaled corticosteroids: current status and future perspectives. Respiratory care. 2015;60(3):455-68.

RI KK, editor Hasil Utama Riskesdas 20182018.

Asthma GIf. Global Strategy for Asthma Management and Prevention 2017. Available from:

Janson C, Menzies-Gow A, Nan C, Nuevo J, Papi A, Quint JK, et al. SABINA: An Overview of Short-Acting beta2-Agonist Use in Asthma in European Countries. Advances in therapy. 2020;37(3):1124-35.

Bloom CI, Cabrera C, Arnetorp S, Coulton K, Nan C, van der Valk RJP, et al. Asthma-Related Health Outcomes Associated with Short-Acting beta2-Agonist Inhaler Use: An Observational UK Study as Part of the SABINA Global Program. Advances in therapy. 2020;37(10):4190-208.

Pearce N, Hensley MJ. Epidemiologic studies of beta agonists and asthma deaths. Epidemiologic reviews. 1998;20(2):173-86.

O'Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma. The New England journal of medicine. 2018;378(20):1865-76.

Bateman ED, Reddel HK, O'Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As-Needed Budesonide-Formoterol versus Maintenance Budesonide in Mild Asthma. The New England journal of medicine. 2018;378(20):1877-87.

Sadatsafavi M, Tavakoli H, Lynd L, FitzGerald JM. Has Asthma Medication Use Caught Up With the Evidence?: A 12-Year Population-Based Study of Trends. Chest. 2017;151(3):612-8.

Reddel HK, FitzGerald JM, Bateman ED, Bacharier LB, Becker A, Brusselle G, et al. GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. The European respiratory journal. 2019;53(6).

Cabrera CS, Nan C, Lindarck N, Beekman M, Arnetorp S, van der Valk RJP. SABINA: global programme to evaluate prescriptions and clinical outcomes related to short-acting beta2-agonist use in asthma. The European respiratory journal. 2020;55(2).

Worth H, Criee CP, Vogelmeier CF, Kardos P, Becker EM, Kostev K, et al. Prevalence of overuse of short-acting beta-2 agonists (SABA) and associated factors among patients with asthma in Germany. Respiratory research. 2021;22(1):108.

Nwaru BI, Ekstrom M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting beta2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. The European respiratory journal. 2020;55(4).

Wang CY, Lai CC, Wang YH, Wang HC. The prevalence and outcome of short-acting beta2-agonists overuse in asthma patients in Taiwan. NPJ primary care respiratory medicine. 2021;31(1):19.

Bateman ED, Price DB, Wang HC, Khattab A, Schonffeldt P, Catanzariti A, et al. Short-acting beta2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. The European respiratory journal. 2021.

Asthma GIf. Global Strategy for Asthma Management and Prevention 2021. Available from:

Cusack RP, Satia I, O'Byrne PM. Asthma maintenance and reliever therapy: Should this be the standard of care? Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2020;125(2):150-5.

Azzi EA, Kritikos V, Peters MJ, Price DB, Srour P, Cvetkovski B, 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.

Gold LS, Thompson P, Salvi S, Faruqi RA, Sullivan SD. Level of asthma control and health care utilization in Asia-Pacific countries. Respiratory medicine. 2014;108(2):271-7.

Suruki RY, Daugherty JB, Boudiaf N, Albers FC. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC pulmonary medicine. 2017;17(1):74.



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Jurnal Respirologi Indonesia
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