It is Time to Change How We Manage Mild Asthma. Written by Dr Aoife O’Reilly & Professor Eleanor Dunican, St. Vincent’s University Hospital and University College Dublin45 – HPN January 2022 Digital
Management of mild asthma has traditionally relied on inhaled corticosteroid (ICS) used regularly for asthma control. This is as well as inhaled short-acting beta agonist (SABA) used as needed for symptom relief. In 2019, the Global Initiative for Asthma (GINA) made a fundamental change to its recommendations for the treatment of asthma. GINA no longer recommends regular use of SABA as a reliever without an ICS.
All patients diagnosed with asthma should be prescribed an ICS, either regularly or as needed for respiratory symptoms. In patients with mild asthma, ICS/formoterol should be used as a reliever instead of regular ICS. This is to avoid the risk of patients reverting to SABA monotherapy. This article outlines the rationale and evidence that supports the most radical change to asthma management in the last 50 years.
SABAs were the first inhaled therapy commonly prescribed for asthma and provide symptomatic relief (within 5 minutes). This was through rapid-onset bronchodilation but have no anti-inflammatory properties. Therefore, with the sudden rise in SABA use in the late 1950s, there was a calamitous rise in asthma deaths in England and Wales, with an almost 400% increase in deaths from asthma in the 5-34 year age group. This sudden epidemic of asthma deaths was thoroughly investigated, and many theories were proposed to explain it.
Managing Mild Asthma Conclusion
Even patients with infrequent asthma symptoms can suffer severe or fatal asthma attacks. Overuse of SABA is associated with increased asthma mortality due to its lack of anti-inflammatory properties and resultant delay in patients seeking medical care. In patients with asthma symptoms less than twice a month, current recommendations are that they should be prescribed as-needed low-dose ICS-formoterol for symptom relief (preferred), or take low dose ICS whenever SABA is needed for symptom relief.
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