Controversies in Allergy: Should I Combine an ICS With a SABA or With Formoterol for Reliever Therapy?

Multiple approaches with inhaler therapies can be used when treating asthma. Inhaled corticosteroids (ICS) reduce airway inflammation, whereas bronchodilators relax airway smooth muscle. Anti-inflammatory reliever (AIR) therapy combines an ICS with quick-onset bronchodilators for use as a rescue therapy. Several AIR strategies have demonstrated efficacy in reducing asthma exacerbations. There are currently 2 inhalers that combine an ICS with a quick onset bronchodilator into a single inhaler: one which combines an ICS with short-acting β₂-agonist (ICS-SABA) and one which combines an ICS with the long-acting β₂-agonist formoterol (ICS-formoterol). Alternatively, AIR therapy can be provided with the ICS and the SABA in 2 separate inhalers. The provider may come across challenges when choosing a specific therapy best suited for each patient, including insurance and regulatory issues. This article reviews the literature on AIR therapy in adult and pediatric populations with asthma along with implementation considerations when choosing a specific AIR strategy.