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The Management of Mild Asthma

Paul M. O'Byrne, Helen K. Reddel, Richard Beasley
European Respiratory Journal 2020; DOI: 10.1183/13993003.03051-2020
Paul M. O'Byrne
1Firestone Institute for Respiratory Health, St. Joseph's Hospital and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Helen K. Reddel
2Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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Richard Beasley
3Medical Research Institute of New Zealand, Wellington, New Zealand
4Capital and Coast District Health Board, Wellington, New Zealand
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Abstract

Inhaled corticosteroids (ICS) 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 (SABA) 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 was to evaluate the efficacy of reliever medications that contain an ICS when compared to SABA as a reliever, or to maintenance ICS and SABA as reliever, in mild asthma patients.

Nine studies were identified which 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.

An 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.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Yan reports grants from National Institutes of Health, during the conduct of the study;.

Conflict of interest: Paul M. O'Byrne

Conflict of interest: Dr. Reddel reports grants and personal fees from AstraZeneca, grants and personal fees from GlaxoSmithKline, personal fees from Merck, personal fees from Novartis, personal fees from Teva, personal fees from Boehringer Ingelheim, personal fees from Sanofi Genzyme, outside the submitted work; and Chair of the GINA Science Committee.

Conflict of interest: Dr. Beasley reports grants and personal fees from AstraZeneca, grants from GlaxoSmithKline, grants from Genentech, personal fees from Avillion, personal fees from Theravance, outside the submitted work.

  • Received August 6, 2020.
  • Accepted October 8, 2020.
  • Copyright ©ERS 2020
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The Management of Mild Asthma
Paul M. O'Byrne, Helen K. Reddel, Richard Beasley
European Respiratory Journal Jan 2020, 2003051; DOI: 10.1183/13993003.03051-2020

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The Management of Mild Asthma
Paul M. O'Byrne, Helen K. Reddel, Richard Beasley
European Respiratory Journal Jan 2020, 2003051; DOI: 10.1183/13993003.03051-2020
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