Overuse of Common Asthma Inhalers Doubles Risk of Death, Major Global Study Warns

New Delhi:  A new global systematic review and meta-analysis has found that overusing short-acting beta-agonist (SABA) inhalers-commonly known as "rescue inhalers" -significantly increases the risk of death and acute exacerbations in people with asthma.

Published in the journal Allergy, the review analyzed data from 27 studies spanning over 40 years and more than 430,000 patients. Patients using three or more SABA inhalers per year had double the risk of mortality (Risk Ratio: 2.04, 95% CI: 1.37–3.04) and nearly double the risk of severe asthma attacks (RR: 1.93, 95% CI: 1.24–3.03), compared to those using fewer.

This is the first meta-analysis of its kind showing that that SABA overuse may not just be ineffective but also dangerous in certain circumstances. The findings strongly reinforce the Global Initiative for Asthma (GINA)’s 2019 recommendation that SABA monotherapy should no longer be used, even for mild asthma. Instead, GINA recommends inhaled corticosteroid (ICS)-based therapy, for both symptom relief and anti-inflammatory control.

The findings also have important implication for a country like India where about 35 million suffer from asthma. A study by leading chest experts in 2022, published in the European Respiratory Journal, showed that over one-third of asthma patients in India use SABA inhalers as monotherapy, with nearly three-fourths exceeding the threshold of three canisters per year. The study also found a significant association between SABA overuse and increased rates of uncontrolled asthma (50% vs. 34%) and asthma-related hospitalizations (24% vs. 8%) compared to those using fewer canisters in Indian patients.