Abstract
Inhaled corticosteroids (ICSs) have been recommended as a maintenance treatment, either alone or together with long-acting inhaled β2-agonists, for all asthma patients. Short-acting β2-agonists (SABAs) are rapid-onset bronchodilators, which provide symptom relief, but have no anti-inflammatory properties, yet are the most widely used as-needed reliever treatment for asthma and often the only treatment prescribed. Asthma patients can find adhering to daily preventative medication with ICS difficult and will often revert to using as-needed SABA as their only treatment, increasing their risk of exacerbations. The purpose of this review is to evaluate the efficacy of reliever medications that contain ICS compared with SABA as reliever, or with maintenance ICS and SABA as reliever, in mild asthma patients.
Nine studies were identified that have evaluated the use of ICS as a component of an as-needed reliever in patients with mild asthma. Four of the most recent studies compared the combination of ICS/formoterol to SABA as reliever.
ICS-containing reliever medication was superior to SABA as reliever alone, and was equivalent to maintenance ICS and SABA as reliever, particularly in reducing risks of severe asthma exacerbations, in studies which compared these reliever options.
SABAs should not be used as a reliever without ICS. The concern about patients with mild asthma not being adherent to maintenance ICS supports a recommendation that ICS/formoterol should be considered as a treatment option instead of maintenance ICS, to avoid the risk of patients reverting to SABA alone.
Abstract
In the management of mild asthma, an ICS-containing reliever medication is superior to SABA as reliever alone, and is equivalent to maintenance ICS and SABA as reliever, particularly in reducing risks of severe asthma exacerbations https://bit.ly/3dovSKc
Footnotes
Number 3 in the series “Innovations in asthma and its treatment” Edited by P. O'Byrne and I. Pavord
Previous articles in this series: No. 1: Asher MI, García-Marcos L, Pearce NE, et al. Trends in worldwide asthma prevalence. Eur Respir J 2020; 56: 2002094. No. 2: Hinks TSC, Levine SJ, Brusselle GG. Treatment options in type-2 low asthma. Eur Respir J 2021; 57: 2000528.
Conflict of interest: P.M. O'Byrne reports personal fees for joint oversight board for LABA safety study, personal fees for consultancy from AstraZeneca, GlaxoSmithKline and Chiesi, grants from AstraZeneca, Genentech, Novartis, Merck and Bayer, outside the submitted work.
Conflict of interest: H.K. Reddel reports grants and personal fees for data monitoring committee work, advisory board work and educational activities from AstraZeneca and GlaxoSmithKline, personal fees for data monitoring committee work from Merck, grants and personal fees for data monitoring committee and advisory board work from Novartis, personal fees for educational activities from Teva, personal fees for educational activities and advisory board work from Boehringer Ingelheim, personal fees for advisory board work from Sanofi Genzyme, outside the submitted work; and is Chair of the GINA Science Committee.
Conflict of interest: R. Beasley reports grants and personal fees from AstraZeneca, grants from GlaxoSmithKline and Genentech, personal fees from Avillion and Theravance, outside the submitted work.
- Received August 6, 2020.
- Accepted October 8, 2020.
- Copyright ©ERS 2021