Short-acting β2-agonist prescription patterns in patients with asthma in Turkey: results from SABINA III
Authors: Yorgancıoğlu Arzu , Aksu Kurtuluş , Naycı Sibel Atış , Ediger Dane , Mungan Dilşad , Gül Umut , Beekman Maarten J. H. I. ,   SABINA Turkey Study Group, Kızılırmak Deniz , Altıntaş Nejat , Bulut İsmet , Çağatay Tülin , Gemicioğlu Bilun , İnce Özgür , Oğuzülgen Kıvılcım , Kalpaklıoğlu Füsun , Baççıoğlu Ayşe , Aksu Funda , Altuntaş Murat , Erkekol Ferda Öner , Karakaya Gül , Kalyoncu Ali Fuat , Damadoğlu Ebru , Hanta İsmail , Altunok Ersoy , Özer Adviye , Yuluğ Demet Polat , Gülbaş Gazi , Süerdem Mecit , Yormaz Burcu , Ceylan Emel , Erge Duygu , Çilli Aykut , Doğan Berat Celil , Erel Fuat , Sevinç Can , Anar Ceyda , Pekbak Gülseren , Erbay Müge 
Published: June 2022

Abstract
Background
Over-reliance on short-acting β2-agonists (SABAs) is associated with poor asthma outcomes. However, the extent of SABA use in Turkey is unclear owing to a lack of comprehensive healthcare databases. Here, we describe the demographics, disease characteristics and treatment patterns from the Turkish cohort of the SABA use IN Asthma (SABINA) III study.

Methods
This observational, cross-sectional study included patients aged ≥ 12 years with asthma from 24 centres across Turkey. Data on sociodemographics, disease characteristics and asthma treatments were collected using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA]) and practice type (primary/specialist care). The primary objective was to describe SABA prescription patterns in the 12 months prior to the study visit.

Results
Overall, 579 patients were included (mean age [standard deviation; SD]: 47.4 [16.1] years; 74.3% female), all of whom were treated by specialists. Most patients had moderate-to-severe asthma (82.7%, GINA steps 3–5), were overweight or obese (70.5%), had high school or university/post-graduate education (51.8%) and reported fully reimbursed healthcare (97.1%). The mean (SD) asthma duration was 12.0 (9.9) years. Asthma was partly controlled/uncontrolled in 56.3% of patients, and 46.5% experienced ≥ 1 severe exacerbation in the preceding 12 months. Overall, 23.9% of patients were prescribed ≥ 3 SABA canisters in the previous 12 months (considered over-prescription); 42.9% received no SABA prescriptions. As few patients had mild asthma, only 5.7% were prescribed SABA monotherapy. Therefore, most patients (61.5%) were prescribed SABA in addition to maintenance therapy, with 42.8% receiving ≥ 3 SABA canisters in the previous 12 months. Inhaled corticosteroids (ICS), ICS + a long-acting β-agonist fixed-dose combination and oral corticosteroids were prescribed to 14.5%, 88.3% and 28.5% of all patients, respectively. Additionally, 10.2% of patients purchased SABA over the counter, of whom 27.1% purchased ≥ 3 canisters in the preceding 12 months.

Conclusions
Despite all patients being treated by specialists and most receiving fully reimbursed healthcare, nearly a quarter of patients received prescriptions for ≥ 3 SABA canisters in the previous 12 months. This highlights a public health concern and emphasizes the need to align clinical practices with the latest evidence-based recommendations.