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