Using a short-acting Beta2 agonist (SABA) inhaler 3 or more times a week is an indicator of increased risk of asthma attacks.1
Experts have co-developed a 5-item questionnaire to assess reliance on SABA inhalers. Click below to view the Reliever Reliance Test.


Over-reliance on SABA inhalers (usually a blue inhaler) is common among people with asthma.2 Many patients feel ‘attached’ to their SABA inhaler, believing this to be the best way to control their symptoms.3

Studies have shown that 90% of asthma patients want fast relief from their symptoms.3,4 Most patients don’t understand that the SABA inhaler they use when they feel symptomatic doesn’t address the underlying cause of their asthma.2,5

Although SABA inhalers provide quick relief of symptoms, over-reliance (e.g. when patients use their SABA inhaler three or more times a week) is associated with an increased risk of exacerbations.1 Meanwhile, patients prescribed three or more SABA canisters per year are more likely to have an asthma attack and even to die prematurely.5,6

Currently, observational studies are underway around the world to evaluate the burden of SABA use in asthma and the resultant negative impact on asthma-related clinical outcomes.

Learn more on from Dr. Alan Kaplan on the issue of SABA over-reliance and the unnecessary risks posed to asthma patients.

In light of the COVID-19 global pandemic and at a time when health systems are overstretched, helping patients to effectively self-manage their asthma and reduce their risk of exacerbation so that they stay out of hospital is now more important than ever before.7 In addition, medical experts agree that for people with asthma, the best way of staying healthy and recovering if infected with COVID-19, is to ensure their asthma is as stable as possible.7

Implementing new clinical approaches and changing behaviour to tackle SABA over-reliance can be a challenge. Evidence shows that discussions between HCPs and patients to support changes in asthma self-management may be more effective if they take into account the patients’ underlying expectations and concerns.8 Adapted from the validated SABA Risk Questionnaire,9 the Reliever Reliance Test is a patient-friendly digital tool designed to identify whether a patient might be over-reliant on their SABA inhaler. Read more about the research behind the tool on

Watch the video to understand the impact of SABA over-reliance on patients and their families, and how an improved health system designed to better manage asthma could make a difference.

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The Reliever Reliance Test is adapted from the validated and globally used Beliefs about Medicines Questionnaire10 and has been developed by leading expert in behavioural medicine, Professor Rob Horne, with colleagues from the International Primary Care Respiratory Group (IPCRG). It was fully funded by AstraZeneca UK Limited. The Asthma Right Care initiative is a global movement led by the IPCRG funded by AstraZeneca globally.

This is not medical advice DO NOT stop or change your asthma medication without consulting your healthcare professional

This is not medical advice. DO NOT stop or change your asthma medication without consulting your healthcare professional.


1. Global Initiative for Asthma (GINA). Available at: (last accessed December 2019).
2. Humbert M, Andersson TL, Buhl R. Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma. Allergy. 2008; 63: 1567–80.
3. Cole S, Seale C, Griffiths C. ‘The blue one takes a battering’ why do young adults with asthma overuse bronchodilator inhalers? A qualitative study. BMJ Open. 2013; 3 (2): e002247.
4. Partridge MR, van der Molen T, Myrseth S-E, et al. Attitudes and actions of asthma patients on regular maintenance therapy: The INSPIRE study. BMC Pulm Med 2006; 6:13.
5. Nwaru BI, Ekström M, Hasvold P, et al. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020;55(4):1901872.
6. Stanford RH, Shah MB, D’Souza AO, et al. Short-acting β-agonist use and its ability to predict future asthma-related outcomes. Annals of Allergy, Asthma & Immunology. 2012; 109: 403-407
7. Asthma and COVID-19: risks and management considerations
8. Pinnock H. Supported self-management for asthma. Breathe (Sheff). 2015; 11 (2): 98-109.
9. Chan AHY, Katzer C, Kaplan A, et al. SABA Reliance Questionnaire (SRQ): a novel screening tool to identify patients’ beliefs underpinning over-reliance on short-acting beta2 agonists in the management of asthma. The Journal of Allergy and Clinical Immunology: In Practice. 2020;
10. Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication, Psychology & Health. 1999; 14 (1): 1-24,


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