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S26 An assessment of short-acting β2-agonist (SABA) use and subsequent greenhouse gas (GHG) emissions in five European countries and the consequence of their potential overuse for asthma in the UK
  1. AJK Wilkinson1,
  2. A Menzies-Gow2,
  3. M Sawyer3,
  4. JP Bell4,
  5. Y Xu5,
  6. N Budgen6,
  7. T Harrison7
  1. 1East and North Hertfordshire NHS Trust, Stevenage, UK
  2. 2Royal Brompton Hospital, London, UK
  3. 3SEE Sustainability, Northallerton, UK
  4. 4BioPharmaceutical Medical, AstraZeneca, Cambridge, UK
  5. 5AstraZeneca UK Marketing Company, Luton, UK
  6. 6Global Sustainability, AstraZeneca, Macclesfield, UK
  7. 7Nottingham Respiratory Research Unit, Nottingham, UK


Introduction The SABA Use IN Asthma (SABINA) programme associates SABA overuse (prescription of ≥3 canisters per year versus 0–2) with increased risk of exacerbations and asthma-related healthcare utilisation1; with this overuse common across Europe.2 In parallel, the environmental impact of inhaler choice receives attention but is often focussed on preventers. We analysed the volume of SABA use and its GHG emissions versus total inhaler devices and compared the U.K. with other European countries. Next, we calculated the annual volume and GHG emissions from SABA overuse in asthma in the U.K. using the SABINA U.K. study data.

Methods Inhaler use was calculated using sales data obtained from life science analytics company IQVIA™ over 12 months to September 2019. Data were compared by dose, preventing confounding from device actuation count differences. SABA overuse volume in asthma i.e. sum of prescribing ≥3 prescriptions in 12 months, was extracted from Clinical Practice Research Datalink GOLD as part of SABINA U.K. (≥12 years, current asthma diagnosis, any severity, 12 month period between 2007–2019). GHG emissions of inhaler devices were estimated using published and internal AstraZeneca data on their full life cycle.

Results SABA represents the majority of inhaler use and of GHG emissions in the U.K. and its neighbours (table 1). However, U.K. SABA use and GHG emissions per capita are approximately treble those of other countries. In SABINA U.K., 284,683 out of 574,913 asthma patients were potentially overusing SABA. The average for this group was 6.51 prescriptions per year. 83% of SABA prescriptions for asthma went to patients overusing SABA. For the U.K. asthma population this represents 9.24 million SABA prescriptions and 250,000 tonnes of CO2[equivalent] annually.

Abstract S26 Table 1

Comparison of U.K. with other European countries on the annual use and impact on greenhouse gas (GHG) emissions of short-acting β2-agonist (SABA) relievers vs total inhaler usage (reliever & preventer)

Conclusion These data demonstrate the GHG emissions associated with high SABA use across Europe and particularly in the U.K. Implementing guidelines to drive improvements in asthma care would improve asthma control, thereby reducing reliever medication use and exacerbation frequency, benefiting patients and realising carbon savings that go beyond the reduction in SABA use alone.


  1. Bloom CI, et al. Adv Ther 2020:

  2. Janson C, et al. Adv Ther 2020: 37; 1124–1135

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