SABINA + Hong Kong: a territory wide study of prescribing trends and outcomes associated with the use of short-acting β2 agonists in the Chinese population

Lydia W.Y. Fung, Vincent K.C. Yan, Christine Kwan, W.C. Kwok, David C.L. Lam, Christine F. McDonald, Chloe I. Bloom, Ian C.K. Wong, Esther W. Chan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Excessive use of short-acting β2 agonists (SABA) in patients with asthma continues to be a notable concern due to its link to higher mortality rates. Global relevance of SABA overuse in asthma management cannot be understated, it poses significant health risk to patients with asthma and imposes burden on healthcare systems. This study, as part of global SABINA progamme, aimed to describe the prescribing patterns and clinical outcomes associated with SABA use in the Chinese population. Methods: Retrospective cohort study was conducted using anonymized electronic healthcare records of Clinical Data Analysis and Reporting System (CDARS) from Hong Kong Hospital Authority (HA). Patients newly diagnosed with asthma between 2011 and 2018 and aged ≥12 years were included, stratified by SABA use (≤2, 3–6, 7–10, or ≥11 canisters/year) during one-year baseline period since asthma diagnosis date. Patients were followed up from one-year post-index until earliest censoring of events: outcome occurrence and end of study period (31 December 2020). Cox proportional regression and negative binomial regression were used to estimate the mortality risk and frequency of hospital admissions associated with SABA use respectively, after adjusting for age, sex, Charlson Comorbidity Index (CCI), and inhaled corticosteroid (ICS) dose. Outcomes include all-cause, asthma-related, and respiratory-related mortality, frequency of hospital admissions for any cause, and frequency of hospital admissions due to asthma. Results: 17,782 patients with asthma (mean age 46.7 years, 40.8% male) were included and 59.1% of patients were overusing SABA (≥ 3 canisters per year). Each patient was prescribed a median of 5.61 SABA canisters/year. SABA overuse during baseline period was associated with higher all-cause mortality risk compared to patients with ≤2 canisters/year. Association was dose-dependent, highest risk in those used ≥11 canisters/year (adjusted hazard ratio: 1.42, 95% CI: 1.13, 1.79) and 3–6 canisters/year (adjusted hazard ratio: 1.22, 95% CI: 1.00, 1.50). Higher SABA prescription volume associated with increased frequency of hospital admissions with greatest risk observed in 7–10 canisters/year subgroup (adjusted rate ratio: 4.81, 95% CI: 3.66, 6.37). Conclusions: SABA overuse is prevalent and is associated with increased all-cause mortality risk and frequency of hospital admissions among the patients with asthma in Hong Kong.
Original languageEnglish
Article number232
Number of pages10
JournalBMC Pulmonary Medicine
Issue number1
Early online date14 May 2024
Publication statusPublished - 14 May 2024

Bibliographical note

Copyright © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
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Data Access Statement

The datasets generated and/or analysed during the current study are not
publicly available as the data custodians (the Hospital Authority of Hong
Kong SAR) has not given permission for sharing due to patient confidentiality
and privacy concerns, but are available from the corresponding author on
reasonable request and with permission from the Hospital Authority of Hong
Kong SAR.


  • Chinese population
  • Asthma
  • Short-acting β2 agonist
  • Mortality
  • Adrenergic beta-2 Receptor Agonists/therapeutic use
  • Practice Patterns, Physicians'/statistics & numerical data
  • Humans
  • Middle Aged
  • Male
  • Asthma/drug therapy
  • Hong Kong/epidemiology
  • Young Adult
  • Adolescent
  • Female
  • Adult
  • Hospitalization/statistics & numerical data
  • Retrospective Studies
  • Aged
  • East Asian People


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