Effective Asthma Management: Is It Time to Let the AIR out of SABA?

Overview

Journal J Clin Med

Specialty General Medicine

Date 2020 Apr 2

PMID 32230875

Citations 26

Authors

Alan Kaplan

Patrick D Mitchell

Andrew J Cave

Remi Gagnon

Vanessa Foran

Anne K Ellis

Affiliations

Soon will be listed here.

Abstract

For years, standard asthma treatment has included short acting beta agonists (SABA), including as monotherapy in patients with mild asthma symptoms. In the Global Initiative for Asthma 2019 strategy for the management of asthma, the authors recommended a significant departure from the traditional treatments. Short acting beta agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy because of significant safety concerns and poor outcomes. Instead, the more appropriate course is the use of a combined inhaled corticosteroid-fast acting beta agonist as a reliever. This paper discusses the issues associated with the use of SABA, the reasons that patients over-use SABA, difficulties that can be expected in overcoming SABA over-reliance in patients, and our evolving understanding of the use of "anti-inflammatory relievers" in our patients with asthma.

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References

Hull S, McKibben S, Homer K, Taylor S, Pike K, Griffiths C . Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London. NPJ Prim Care Respir Med. 2016; 26:16049. PMC: 4989925. DOI: 10.1038/npjpcrm.2016.49. View

Chen W, FitzGerald J, Lynd L, Sin D, Sadatsafavi M . Long-Term Trajectories of Mild Asthma in Adulthood and Risk Factors of Progression. J Allergy Clin Immunol Pract. 2018; 6(6):2024-2032.e5. DOI: 10.1016/j.jaip.2018.04.027. View

Chapman K, Verbeek P, White J, Rebuck A . Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. N Engl J Med. 1991; 324(12):788-94. DOI: 10.1056/NEJM199103213241202. View

Price D, Fletcher M, van der Molen T . Asthma control and management in 8,000 European patients: the REcognise Asthma and LInk to Symptoms and Experience (REALISE) survey. NPJ Prim Care Respir Med. 2014; 24:14009. PMC: 4373302. DOI: 10.1038/npjpcrm.2014.9. View

Kang H, Song H, Nam J, Hong S, Yang S, Ju S . Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea. BMJ Open. 2018; 8(3):e020825. PMC: 5875610. DOI: 10.1136/bmjopen-2017-020825. View

Cole S, Seale C, Griffiths C . 'The blue one takes a battering' why do young adults with asthma overuse bronchodilator inhalers? A qualitative study. BMJ Open. 2013; 3(2). PMC: 3586109. DOI: 10.1136/bmjopen-2012-002247. View

Reddel H, Busse W, Pedersen S, Tan W, Chen Y, Jorup C . Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study. Lancet. 2016; 389(10065):157-166. DOI: 10.1016/S0140-6736(16)31399-X. View

Voorham J, Xu X, Price D, Golam S, Davis J, Ling J . Healthcare resource utilization and costs associated with incremental systemic corticosteroid exposure in asthma. Allergy. 2018; 74(2):273-283. PMC: 6587525. DOI: 10.1111/all.13556. View

Gauvreau G, Jordana M, Watson R, Cockroft D, OByrne P . Effect of regular inhaled albuterol on allergen-induced late responses and sputum eosinophils in asthmatic subjects. Am J Respir Crit Care Med. 1997; 156(6):1738-45. DOI: 10.1164/ajrccm.156.6.96-08042. View

10.

Sobieraj D, Weeda E, Nguyen E, Coleman C, White C, Lazarus S . Association of Inhaled Corticosteroids and Long-Acting β-Agonists as Controller and Quick Relief Therapy With Exacerbations and Symptom Control in Persistent Asthma: A Systematic Review and Meta-analysis. JAMA. 2018; 319(14):1485-1496. PMC: 5876810. DOI: 10.1001/jama.2018.2769. View

11.

Haahtela T, Jarvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K . Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med. 1991; 325(6):388-92. DOI: 10.1056/NEJM199108083250603. View

12.

Stanford R, Shah M, DSouza A, Dhamane A, Schatz M . Short-acting β-agonist use and its ability to predict future asthma-related outcomes. Ann Allergy Asthma Immunol. 2012; 109(6):403-7. DOI: 10.1016/j.anai.2012.08.014. View

13.

Bateman E, Reddel H, OByrne P, Barnes P, Zhong N, Keen C . As-Needed Budesonide-Formoterol versus Maintenance Budesonide in Mild Asthma. N Engl J Med. 2018; 378(20):1877-1887. DOI: 10.1056/NEJMoa1715275. View

14.

OByrne P, FitzGerald J, Bateman E, Barnes P, Zhong N, Keen C . Inhaled Combined Budesonide-Formoterol as Needed in Mild Asthma. N Engl J Med. 2018; 378(20):1865-1876. DOI: 10.1056/NEJMoa1715274. View

15.

Spitzer W, Suissa S, Ernst P, Horwitz R, Habbick B, Cockcroft D . The use of beta-agonists and the risk of death and near death from asthma. N Engl J Med. 1992; 326(8):501-6. DOI: 10.1056/NEJM199202203260801. View

16.

OByrne P, Jenkins C, Bateman E . The paradoxes of asthma management: time for a new approach?. Eur Respir J. 2017; 50(3). DOI: 10.1183/13993003.01103-2017. View

17.

Papi A, Ryan D, Soriano J, Chrystyn H, Bjermer L, Rodriguez-Roisin R . Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. J Allergy Clin Immunol Pract. 2018; 6(6):1989-1998.e3. DOI: 10.1016/j.jaip.2018.03.008. View

18.

Rowe B, Villa-Roel C, Abu-Laban R, Stenstrom R, Mackey D, Stiell I . Admissions to Canadian hospitals for acute asthma: a prospective, multicentre study. Can Respir J. 2010; 17(1):25-30. PMC: 2866213. DOI: 10.1155/2010/178549. View

19.

Crane J, Pearce N, Flatt A, Burgess C, Jackson R, Kwong T . Prescribed fenoterol and death from asthma in New Zealand, 1981-83: case-control study. Lancet. 1989; 1(8644):917-22. DOI: 10.1016/s0140-6736(89)92505-1. View

20.

Beasley R, Bird G, Harper J, Weatherall M . The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity. Eur Respir J. 2018; 52(5). DOI: 10.1183/13993003.00694-2018. View