The management of mild asthma

Area of Science:

• Pulmonology
• Allergy and Immunology
• Pharmacology

Background:

• Inhaled corticosteroids (ICSs) are recommended for persistent asthma, often with long-acting beta2-agonists (LABAs).
• Short-acting beta2-agonists (SABAs) are widely used for quick symptom relief but lack anti-inflammatory effects.
• Poor adherence to daily ICS maintenance therapy is common, leading patients to rely solely on SABAs, increasing exacerbation risk.

Purpose of the Study:

• To evaluate the efficacy of reliever medications containing ICS compared to SABA-only or maintenance ICS/SABA reliever strategies in mild asthma patients.
• To assess the potential of ICS-containing relievers to mitigate risks associated with SABA-only use.

Main Methods:

• Systematic review of nine studies evaluating ICS as a component of as-needed reliever therapy in mild asthma.
• Focus on four recent studies comparing ICS/formoterol combination therapy with SABA as reliever.

Main Results:

• ICS-containing reliever medications demonstrated superiority over SABA alone in managing mild asthma.
• ICS/formoterol as a reliever was found to be equivalent to maintenance ICS plus SABA reliever in reducing severe asthma exacerbations.
• These findings highlight the efficacy of ICS in reliever inhalers.

Conclusions:

• Short-acting beta2-agonists (SABAs) should not be used as a reliever medication without inhaled corticosteroids (ICSs).
• Given adherence challenges with daily ICS maintenance, ICS/formoterol as a reliever presents a viable alternative treatment option.
• This approach can help prevent patients from reverting to SABA-only use and reduce exacerbation risks.