Accessibility of OTC Short-Acting Beta-2 Agonists Contributes to Overuse for Asthma


Many patients would like more education about managing their asthma, which can help to reduce the overuse of short-acting beta-2 agonists.

The accessibility of short-acting beta-2 agonists (SABAs) for the treatment of asthma as needed has contributed to the medication being overused, resulting in more patient education and management for those who have asthma to help reduce the overuse of SABAs, according to a systematic review of OTC SABA medication.1

Doctor writes medical prescription for asthma inhaler to asthmatic patient during medical consultation and examination in hospital | Image Credit: Goffkein -

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OTC SABA products include albuterol (Ventolin; GlaxoSmithKline plc), levalbuterol (Xopenex, Akorn Operating Company LLC), and albuterol with ipratropium bromide (DuoNeb; Dey Pharma LP). They are recommended to be taken twice a day for long-term maintenance of the airways, according to the Cleveland Clinic.2

The excessive use of these medications has been linked to an increased risk of asthma attacks, exacerbation, and, in some cases, death, according to the study authors. In the review, investigators aimed to determine the prevalence, characteristics, and factors of OTC SABA overuse.1

The investigators examined articles from PubMed, Scopus, Springer Link, Google Scholar, CINAHL, and APA PsycArticles. This included articles reporting the prevalence, characteristics, and factors of OTC SABA use and published in English between 2000 and April 2024. A total of 18 articles were included, meeting the criteria.1

The studies represented 11 high-income countries, including Australia, Chile, Italy, Kuwait, Oman, Saudi Arabia, Singapore, South Africa, South Korea, Taiwan, and the United Arab Emirates, according to the study authors. High-middle income countries included Argentina, Brazil, China, Columbia, Costa Rica, Malaysia, Mexico, Russia, Thailand, and Turkey, while low- and middle-income countries included Egypt, India, Indonesia, Kenya, and the Philippines.1

The study authors reported that the prevalence of OTC SABA users ranged from 1.4% to 3.9%, with 14% to 66.4% purchasing 2 or more SABA canisters over a 12-month period. Australia had the highest prevalence of OTC SABA purchasers, followed by Egypt, South Africa, and Kenya.1

Additionally, Australia’s overuse decreased between 2005 and 2017, with 39.6% and 24.3% of individuals reporting OTC SABA use, respectively. Furthermore, 70.1% to 73.9% of individuals who had asthma reported that they used the SABA product more than twice a week within the past 4 weeks, according to the study results.1

They also found the overuse was associated with moderate to severe asthma and less use of preventers. Additionally, most of the included studies showed that OTC SABA users also had SABA prescriptions, ranging from 29.4% to 80.4% receiving 3 or more SABA prescriptions and 13.5% to 56.7% were prescribed 10 or more in the past year. The OTC SABA users or over-users were also more likely to have uncontrolled asthma, according to the study authors, with worsening symptoms, more frequent physician’s visits, and moderate-to-severe nasal symptoms.1

Furthermore, the risk of SABA overuse was not understood by a majority of individuals across the studies. The study authors found that the purchase of OTC SABAs was linked to patients’ perceived control over asthma, the level of information about their asthma, choice of health care provider, level of medication affordability, and personal preferences.1

They indicated that the overuse of these medications could be due to concerns about the safety of inhaled corticosteroids or lack of awareness regarding the risks of SABA use. The authors reported that patients wanted more information and discussion about asthma and that physicians should be more attentive to asthma. Further, there were misconceptions regarding the individual’s asthma condition that contributed to OTC SABA use or overuse, according to the investigators.1


  1. Loh ZC, Hussain R, Ong SC, Saini B, et al. Over-the-counter use of short-acting beta-2 agonists: a systematic review. J Pharm Policy Pract. 2023;16(1):119. doi:10.1186/s40545-023-00627-z
  2. Cleveland Clinic. Bronchodilator. August 9, 2022. Accessed October 13, 2023.
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