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The SABINA study of SABA inhaler usage and risk of asthma exacerbations, funded by AstraZeneca, is the largest real-world observational data analysis of asthma inhaler therapy and includes more than one million patients in 40 countries. At Queen Mary University of London, a study of more than 700,000 patient records, evaluated SABA inhaler usage, patterns of prescribing and rates of asthma-related hospitalizations. 38 OctOber 2022 Inhalation BACK PAGES Study of more than one million patients adds to evidence of SABA overuse New findings, announced by AstraZenaca, from the largest real- world observational data analysis of asthma inhaler therapy, demon- strated that short-acting beta 2 - agonist (SABA) reliever overuse adversely impacts asthma out- comes and is a global concern. Results from the SABINA pro- gram were published in the Euro- pean Respiratory Journal and in the Journal of Allergy and Clinical Immunology: In Practice. Studying more than one million patients globally An AstraZeneca news release de- scribed the SABA Use IN Asthma (SABINA) program as the largest real-world data analysis of clin- ical outcomes related to SABA use and maintenance therapy in asthma. Funded by the company, it consists of harmonized, large- scale, observational studies across 40 countries. e SABINA program is used to examine patterns of prescribing and receiving SABA and inhaled corticosteroid (ICS)- containing medications as a surrogate mea- sure of medication use. The studies evaluate diverse asthma populations, healthcare systems and asthma management strat- egies on data collected between 2007 and 2017. More than one million patients globally are included in the pro- gram, which has four main pillars: • SABINA I: a retrospective observational database study in the United Kingdom • SABINA II: a retrospective observational database study in eight countries (France, Ger- many, Italy, Netherlands, Spain, Sweden, Canada and Israel) • SABINA III: a cross-sectional study conducted in 24 coun- tries across five continents • SABINA +: a multi-design extended pillar for countries that joined after initiation of the program (China, Hong Kong, Morocco, Poland, Portu- gal, Romania, Switzerland and the United States) Comparing SABA and ICS medications e SABINA study published in the Journal of Allergy and Clinical Immunology: In Practice provided the following brief descriptions of the benefits and limitations of the SABA and ICS-containing medi- cations being evaluated: "When used acutely, short- acting beta 2 -agonists (SABAs) provide rapid symptom relief and can be life-saving. However, beta 2 - agonists have no inherent anti- inflammatory activity, and their use without concomitant inhaled corticosteroids (ICS) may be proinflammatory." "Budesonide-formoterol (ICS and a fast-acting bronchodilator fixed-dose combination) used as a rescue/reliever or as mainte- nance and rescue/reliever reduces exacerbation risk in patients with asthma aged 12 years or older of all severities compared with as- needed SABA, budesonide main- tenance plus as-needed SABA, or budesonide-formoterol mainte- nance plus as-needed SABA." At risk of severe exacerbations AstraZeneca noted there are as many as 339 million adults and