Adherence to inhaled corticosteroids (ICS) in asthma is suboptimal. Patients may rely more on their short-acting beta-agonist (SABA) to control symptoms, which may increase their risk of exacerbations and uncontrolled asthma. Our objective is to describe ICS adherence and SABA use among Dutch primary care patients with asthma, and how these are related to exacerbations and self-reported asthma control. Patients aged ≥12 years diagnosed with asthma who received ≥2 inhalation medication prescriptions in 2016 were selected from the Nivel Primary Care Database. ICS adherence (continuous measure of medication availability), SABA use (number of prescriptions), exacerbations (short courses of oral corticosteroids with daily dose ≥20 mg), and asthma control (self-reported with the Asthma Control Questionnaire; ACQ) were computed. Multilevel logistic regression analyses, to account for clustering of patients within practices, were used to model associations between ICS adherence, SABA use, and asthma outcomes. Prescription data of 13,756 patients were included. ICS adherence averaged 62% (SD: 32.7), 14% of patients received ≥3 SABA prescriptions, and 13% of patients experienced ≥1 exacerbation. Self-reported asthma control was available for 2183 patients of whom 51% reported controlled asthma (ACQ-5 score <0.75). A higher number of SABA prescriptions was associated with a higher risk of exacerbations and uncontrolled asthma, even with high ICS adherence (>90%). ICS adherence was not associated with exacerbations, whilst poor ICS adherence (≤50%) was associated with uncontrolled asthma. In conclusion, increased SABA use is an important and easily identifiable signal for general practitioners to discuss asthma self-management behavior with their patients.

哮喘患者对吸入皮质类固醇 (ICS) 的依从性并不理想。患者可能更多地依赖他们的短效 β-受体激动剂 (SABA) 来控制症状，这可能会增加他们出现哮喘发作和不受控制的哮喘的风险。我们的目标是描述荷兰初级保健哮喘患者的 ICS 依从性和 SABA 使用，以及这些与恶化和自我报告的哮喘控制有何关系。2016 年接受 ≥ 2 次吸入药物处方的 ≥ 12 岁被诊断患有哮喘的患者选自 Nivel 初级保健数据库。计算了 ICS 依从性（药物可用性的连续测量）、SABA 使用（处方数量）、恶化（每日剂量≥20 mg 的短期口服皮质类固醇）和哮喘控制（使用哮喘控制问卷自我报告；ACQ） . 多级逻辑回归分析用于解释实践中患者的聚类，用于模拟 ICS 依从性、SABA 使用和哮喘结果之间的关联。包括 13,756 名患者的处方数据。ICS 依从性平均为 62%（SD：32.7），14% 的患者接受了≥3 次 SABA 处方，13% 的患者经历了≥1 次恶化。2183 名患者自我报告的哮喘控制情况可用，其中 51% 的患者报告哮喘得到控制（ACQ-5 评分 <0.75）。更高数量的 SABA 处方与更高的恶化和不受控制的哮喘风险相关，即使 ICS 依从性高 (>90%) 也是如此。ICS 依从性与恶化无关，而 ICS 依从性差 (≤50%) 与未控制的哮喘有关。综上所述，