<b>Background:</b> SABINA III showed that 18% of patients with asthma across 24 countries purchased SABA OTC;¹ however, the clinical burden of such unregulated access to SABA is not known. <b>Objective:</b> To evaluate the clinical characteristics and outcomes of patients with asthma who purchase SABA OTC. <b>Methods:</b> This post-hoc analysis of SABINA III included patients with asthma aged ≥12 years with SABA prescriptions and/or self-reported OTC SABA purchase (canisters/year). <b>Results:</b> Of the 8351 patients in SABINA III, 318 had only OTC SABA, 3732 had only SABA prescriptions, and 1101, both prescriptions+OTC SABA (Table 1A). A higher proportion of patients with only OTC SABA vs the other groups were treated in primary care (36.2% vs 19.2% and 14.2%) and had no healthcare reimbursement (47.8% vs 23.8% and 35.5%). Of the 2927 patients prescribed ≥3 SABA canisters, 443 (15.1%) also had ≥3 OTC SABA. These 15.1% had a mean of 2.5 severe exacerbations in the previous year; 78.3% of them had ≥1 severe exacerbation and 65.2% had uncontrolled asthma (Table 1B). <b>Conclusion:</b> A subset of patients with ≥3 SABA canister prescriptions also purchased ≥3 SABA canisters OTC. These patients had a relatively high disease burden, emphasising the need for regular asthma reviews, for pharmacists to play a key role in monitoring SABA purchase, as well as policy changes to regulate SABA purchase and ensure access to affordable asthma care.