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SABA Risk Questionnaire (SRQ): a novel method for assessing patients’ beliefs underpinning over-reliance on SABA in the management of asthma

Horne R 1 , Chan A 1 , Haughney J 2 , Kaplan A 3 , Correia de Sousa J, Williams S 4

1 Centre of Behavioural Medicine, School of Pharmacy, UCL, London



4 International Primary Care Respiratory Group, London

Background: Over-reliance on short-acting beta-agonists (SABA) increases the risk of asthma attacks 1 A key driver of SABA over-reliance is patient treatment beliefs. Many patients see asthma as a short-term episodic condition rather than a long-term condition, thus reinforcing reliance on SABA based on personal need for rapid symptom relief. Assessing individual patient beliefs about SABA can help identify patients at risk of SABA over-reliance and allow early intervention.

Aim: To develop and validate a questionnaire for assessing patient beliefs about SABA, which can identify patients at risk of SABA over-reliance.

Method: A series of statements assessing patients perceptions SABA were adapted from the validated  Beliefs about Medicines Questionnaire 2 . The BMQ is a widely-used and well-validated questionnaire for assessing patient treatment belief s , translated into over x languages. Thirteen statements related to beliefs about SABA were developed, which was later reduced to 5 statements after expert consensus review to form SRQ.

Participants were recruited via Amazon MTurk, an online survey platform. Those with self-reported asthma were invited to complete the SRQ, visual analogue scale (VAS) scales rating their perceptions of the relative importance of reliever and preventer inhalers, and the Medication Adherence Report Scale for inhaled corticosteroids (MARS-ICS) 3 .

Results:  A total of 446 people completed the 5 item SRQ.  Internal reliability was good with Cronbach’s α= 0.74. Criterion validity was demonstrated by significant correlation between SRQ scores and reliever importance (r=0.216, p<0.0001), and inverse correlation between SRQ scores and MARS-ICS (r= -0.291, p<0.0001). Discriminant validity was demonstrated by statistically significant differences in SRQ scores between those with high vs low ICS adherence scores (MARS-ICS F=21.989, t=4.825, p<0.0001).

Conclusion: The SRQ demonstrated acceptable internal reliability, criterion and discriminant validity, supporting its potential utility as a pragmatic tool in primary care for identifying patients' beliefs that may put them at risk of SABA over-reliance and flag those who would benefit from an asthma medication review.


1. Pavord ID, Beasley R, Agusti A, et al. After asthma: redefining airways diseases. The Lancet 2018; 391 (10118): 350-400.

2. 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 : 1-24.

3. Cohen JL, Mann DM, Wisnivesky JP, et al. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma. Ann Allergy Asthma Immunol 2009; 103 (4): 325-31.