Asthma affects an estimated 262 million people worldwide, according to the World Health Organization. In Spain, approximately 3 million people live with this condition, based on estimates from the Center for Biomedical Research on Respiratory Diseases, Madrid, Spain.
Despite major therapeutic advances, poor asthma control remains a widespread problem. The excessive and prolonged use of rescue medications is the leading contributor. A 2020 Spanish observational study pointed to inappropriate prescribing, poor treatment adherence, and incorrect inhaler techniques as key factors.
Rescue Therapies
Rescue medications are designed to provide rapid relief from the symptoms. These include short-acting beta-2 agonists (SABAs), most commonly prescribed in clinical practice, and short-acting muscarinic antagonists (SAMAs).
Studies and guidelines, including the Spanish Asthma Guidelines (GEMA 5.5), have previously linked frequent SABA with adverse clinical outcomes, including higher rates of disease worsening and a higher risk for mortality.
A study by Spain’s Spanish Society of Primary Care Physicians (SEMERGEN) Respiratory Working Group, published in the Journal of Clinical Medicine, analyzed SAMA use in asthma outcomes.
Researchers found that frequent SAMA use was associated with poorer asthma control, suggesting that it may serve as a marker of disease severity. Unlike the well-established link between SABA overuse and poor outcomes, the prognostic role of SAMA use has been less examined.
Clinical Gaps
Pharmacologically, SAMAs resemble SABAs in their short duration of action (approximately 4-6 hours), rapid onset, though slower than SABAs, and lack of anti-inflammatory effects. However, the long-term clinical consequences of SAMA overuse remain unclear. Researchers have emphasized that their work is the first to identify this clinical and regulatory disparity.
While international guidelines, such as GINA 2025, advise against SABA monotherapy and define risk thresholds, there are no specific recommendations on SAMA use despite their routine use in clinical practice.
On the basis of these findings, the authors proposed that frequent SAMA use should be treated as an early clinical warning sign that can be easily measured through electronic medical records and incorporated into automated monitoring and decision-making systems.
Study Details
The findings were obtained from a primary care-based cohort of 132 asthma patients, selected via stratified random sampling from electronic medical records at two Spanish National Health System centers in Valencia and Seville.
The analysis included 12 months of retrospective clinical and pharmacologic data for each patient, allowing a comprehensive evaluation of medication patterns and outcomes.
According to the authors, these data are directly applicable to everyday clinical practice and strengthen the role of primary care professionals in research and evidence-based treatment decisions.
The study challenges the traditional focus on SABA overuse as the primary indicator of poor asthma control.
In an official statement, the SEMERGEN noted:
“This work opens the door to using SAMA rescue medication not only as an indicator of poor control, but also as an indicator of the use of healthcare resource utilization and the prescription of oral corticosteroids or antibiotics.”
This story was translated from Univadis Spain.