AstraZeneca launches campaign to reduce over-reliance on SABA ‘blue’ inhaler use in asthma treatment

Baar, 10 September 2020 - The Break Over-Reliance campaign was launched today on social and digital media sites to make people with asthma aware that three or more puffs of their SABA ‘blue’ inhaler per week may increase their risk of asthma attacks. The international campaign is the result of a partnership with the Global Allergy and Airways Patient Platform (GAAPP). At the heart of the campaign is a digital tool to help patients assess how much they are using their SABA and to encourage them to contact their doctor if they are using it excessively.

The Break Over-Reliance campaign aims to help patients with asthma and healthcare professionals understand that over-reliance on the use of SABA ‘blue’ inhalers may increase their risk of asthma attacks.1-3 SABA is short for “short-acting beta2-agonist”. The campaign provides an evidence-based digital tool, the Reliever Reliance Test, to assess a patient’s reliance on their SABA.4 The five-item questionnaire is the first of its kind, and has been adapted from the validated SABA Risk Questionnaire.5 It is aimed at helping patients with asthma to have relevant conversations with their doctor about how best to control their asthma.4

Many patients feel ‘attached’ to their SABA inhaler, mistakenly believing this to be the best way to control their symptoms,” said Andrea Mugan, Country President of AstraZeneca Switzerland. “They are often unaware that using their SABA inhaler just three or more times a week is a sign of poor asthma control and increases their risk of an asthma attack.1,6,7 The Reliever Reliance Test will help patients with asthma to understand whether they might be relying too heavily on their SABA ‘blue’ inhaler and facilitate conversations with their health professionals about their asthma management.

Andrea Mugan Country President AstraZeneca Switzerland

Over-reliance on SABAs in asthma treatment has been evident in clinical practice to date

For decades, the treatment of asthma has involved two different types of inhaler – a ‘controller’ inhaler containing inhaled corticosteroids (ICS), and what is known as a ‘reliever’ inhaler to provide rapid symptom relief by dilating the bronchi. In Switzerland, reliever inhalers are blue and contain a SABA1,8. Asthma patients frequently underuse anti-inflammatory maintenance therapy and instead over-rely on SABA rescue therapy that provides rapid and temporary relief, but can mask the worsening of symptoms.9-12 A SABA alone is not effective against the underlying inflammation, leaving patients exposed to the risk of asthma exacerbation9-12 and potentially burdened by having to take frequent doses of oral corticosteroids.10,13

Global asthma treatment recommendations updated

The link between SABA overuse and an increased risk of asthma attacks has recently led to updated recommendations from the Global Initiative for Asthma (GINA) that seek to avoid establishing a pattern of reliance on SABA early in the disease.1 GINA now no longer recommends SABA as the preferred as-required reliever therapy and instead recommends the use of a combination of an ICS and formoterol to treat all asthma severities.1 These updated global recommendations have overturned decades of asthma care and represent the most significant change in asthma management in over 30 years.

Evidence suggests that healthcare systems are hard-wired to facilitate habitual SABA overuse and over-reliance. Given the recent updates to global asthma management recommendations backed by leading experts, AstraZeneca developed the Break Over-Reliance public health campaign to inform and educate patients and healthcare professionals about the potential dangers of SABA over-reliance and the urgent need to address this issue. AstraZeneca is committed to working with the asthma community to provide tools that aim to eliminate preventable asthma attacks.

Asthma is a common disease

Asthma is a chronic inflammatory respiratory disease characterized by sudden attacks of breathlessness and coughing. In Switzerland, one in ten children and one in fourteen adults are affected.14 The disease is characterized by episodes the severity and frequency of which vary from patient to patient.1

All asthma patients are at risk of severe attacks, regardless of their disease severity, adherence to treatment or level of asthma control.15-17 There are an estimated 176 million asthma attacks globally every year;18 these attacks may be physically threatening and emotionally significant for many patients.19

The Reliever Reliance Test

The Reliever Reliance Test (RRT) was developed by a leading expert in behavioral medicine, Professor Rob Horne, University College London (UCL), with colleagues from the International Primary Care Respiratory Group (IPCRG), and was fully funded by AstraZeneca. The RRT is a five-item questionnaire adapted from the validated SABA Risk Questionnaire, which in turn is derived from the validated Beliefs about Medicines Questionnaire (BMQ), also developed by Professor Rob Horne, UCL.5

The RRT is an evidence-based, practical tool that aims to assess patients’ reliance on their SABA inhaler.4 It is available in both print and digital format. Based on patients’ responses to the five questions, the RRT provides a score indicating whether the patient is likely to be at high, medium or low risk of over-relying on their SABA inhaler.4 The score categories are aimed at helping patients understand their use of SABA, and to create an awareness of over-reliance on SABA and the associated risks.5 Patients can download their results via the digital tool and use them to discuss their asthma control and any potential for treatment optimization with their doctor.

You can find out more about the Reliever Reliance Test at

AstraZeneca’s Focus on Respiratory & Immunology

Respiratory & Immunology is one of AstraZeneca’s three therapy areas and is a key growth driver for the Company.

Building on a 50-year heritage, AstraZeneca is an established leader in respiratory care across inhaled and biologic medicines. AstraZeneca aims to transform the treatment of asthma and chronic obstructive pulmonary disease (COPD) by eliminating preventable asthma attacks across all severities and removing COPD as a leading cause of death through earlier, biology-led treatment.


AstraZeneca (LSE/STO/NYSE: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialization of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, Cardiovascular, Renal and Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide.

AstraZeneca in Switzerland

AstraZeneca has 120 employees who are responsible for coordinating business operations in Switzerland. Our site in Baar is also the headquarters of the Europe & Canada Commercial Regional Team and the Europe & International Oncology Team, which employ a further 40 staff in Switzerland. Our primary therapeutic areas are Oncology, Cardiovascular, Renal and Metabolism, and Respiratory & Immunology. To meet our climate goals ahead of schedule, we are working tirelessly to further reduce CO2 emissions and waste. As part of our Ambition Zero Carbon strategy, we are transitioning to a carbon-free business operation by taking steps to reduce and ultimately eliminate greenhouse gas emissions. In 2020, AstraZeneca Switzerland was recognized by its employees for the third time as an outstanding employer, and was awarded the external “Great place to work®” certification.

Find out more:

AstraZeneca Switzerland Media Department

Tel. +41 (0) 41 725 75 75;
Dr. Angelika März, Corporate Affairs Lead


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3. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. Lancet. 2017; 391: 350-400.

4. International Primary Care Respiratory Group. Blue Reliever Reliance Test. Available at: [Last access: September 2020]

5. Chan AHY, Katzer C, Kaplan A, et al. SABA Reliance Questionnaire (SRQ): Identifying Patient Beliefs Underpinning Reliever Overreliance in Asthma. J Allergy Clin Immunol Pract. 2020;

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12. Larsson, K., Kankaanranta, H., Janson, C. et al. Bringing asthma care into the twenty-first century. NPJ Prim. Care Respir. Med. 2020; 30, 25,

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14. Lungenliga Schweiz [Last access: September 2020]

15. Papi A, Ryan D, Soriano JB, et al. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract 2018; 6: 1989-1998.e3.

16. Bloom CI, Nissen F, Douglas IJ, et al. Exacerbation risk and characterisation of the UK's asthma population from infants to old age. Thorax 2018; 73: 313–320.

17. Ding B, Small M. Disease burden of mild asthma: findings from a cross-sectional real-world survey. Adv Ther. 2017; 34: 1109–1127.

18. AstraZeneca Pharmaceuticals. Data on file. Annual Rate of Exacerbations Globally (February 2019; ID:SD-3010-ALL-0017).

19. Sastre J, Fabbri LM, Price D, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016; 9: 13.

CH-3081, 09/2020
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