PT - JOURNAL ARTICLE AU - O'Byrne, Paul M. AU - Jenkins, Christine AU - Bateman, Eric D. TI - The paradoxes of asthma management: time for a new approach? AID - 10.1183/13993003.01103-2017 DP - 2017 Sep 01 TA - European Respiratory Journal PG - 1701103 VI - 50 IP - 3 4099 - http://erj.ersjournals.com/content/50/3/1701103.short 4100 - http://erj.ersjournals.com/content/50/3/1701103.full SO - Eur Respir J2017 Sep 01; 50 AB - Poor adherence to maintenance pharmacotherapy is a reality in asthma. Studies confirm that when symptoms worsen, most patients increase short-acting β2-agonist (SABA) use, instead of using controller medication. This behaviour might be attributable to several paradoxes in the current treatment approach. These paradoxes include the recommended use of a SABA bronchodilator alone at Global Initiative for Asthma (GINA) step 1, despite the fact that asthma is a chronic inflammatory disease. At step 1, the patient has autonomy and their perception of need and disease control is accepted, but at higher asthma treatment steps a fixed-dose approach is recommended, irrespective of symptom severity. The unintended consequence is the establishment of a pattern of early over-reliance on SABA. New approaches that avoid these paradoxes are needed, such as patient-adjusted therapy, in which patients adopt a symptom-driven approach using a combination reliever/controller. We propose that SABA reliever monotherapy should be replaced by a combination of inhaled corticosteroid (ICS) and formoterol, or similar rapid-onset bronchodilator, as reliever therapy for patients at GINA steps 1 or 2. This will ensure early and more regular administration of a controller medication. However, a significant body of clinical data will be needed before this approach can be approved by regulatory authorities.Paradoxes in asthma management, counterproductive in achieving optimal control, highlight a need for new approaches http://ow.ly/7ikh30e2tOV