Abstract
The role of as-needed inhaled short-acting β2-agonists (SABAs) in the management of asthma has become a subject of debate due to differing opinions in the professional community relating to the use of SABAs. In this article, we summarize the current position of SABAs when used as reliever medications and examine the challenges to appropriate use including a critique of the data that have led to the condemnation of SABA used as a reliever. We consider the evidence for the appropriate use of SABA as a reliever together with practical solutions to ensure such use, including identifying patients at risk of misusing their SABA relievers and managing issues of inhaler technique and treatment adherence. We conclude that inhaled corticosteroid (ICS)-based maintenance treatment with SABA used as-needed as a reliever is an effective and safe treatment for patients with asthma, with no scientific evidence of a causal link between SABA use as a reliever and mortality or serious adverse events (including exacerbations). Increased SABA use warns of a deterioration in asthma control, and patients at risk of misusing their ICS and SABA medication should be rapidly identified to ensure they are receiving adequate ICS-based controller therapy. Appropriate use of ICS-based controller therapy and as-needed SABA should be encouraged and promoted with educational activities.
| Original language | English |
|---|---|
| Pages (from-to) | 2927-2943 |
| Number of pages | 17 |
| Journal | Advances in Therapy |
| Volume | 40 |
| Issue number | 7 |
| DOIs |
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| State | Published - Jul 2023 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2023, The Author(s).
Funding
This work was supported by GSK. The Rapid Service and Open Access Fees for publication were funded by GSK. We thank Sourabh Fulmali and Ebru Yildiz for their intellectual inputs. This work was supported by GSK. The Rapid Service and Open Access Fees for publication were funded by GSK. Editorial support in the form of writing assistance (draft preparation and copyediting) was provided by Kate Hollingworth of Continuous Improvement Ltd, UK, and was funded by GSK. All authors meet the International Committee of Medical Journal Editors authorship criteria, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors participated in drafting the manuscript and/or revising it critically for content and gave final approval of the version to be published. Israel Amirav has no competing interests to declare. Gabriel Garcia has received advisory board consulting fees from Chiesi, GSK, Novartis and Sanofi; and has received support to attend conferences from GSK, Novartis and Sanofi. Le Khac Bao has received honoraria for lectures, presentations, speakers’ bureaus or educational events from Abbott, AstraZeneca, Boehringer Ingelheim, GSK, Pfizer and Novartis; honoraria for providing expert advice in advisory boards from Boehringer Ingelheim, GSK and Pfizer; and support for travel/attending meetings from AstraZeneca, Boehringer Ingelheim and Pfizer. Paulina Barria has received honoraria for lecture presentations from GSK and Sanofi-Aventis; honoraria for providing expert advice in advisory boards/expert forums from AstraZeneca, GSK and Novartis; and support for travel/attending meetings from GSK and Sanofi-Aventis. Thitiwat Sriprasart has no competing interests to declare. Gur Levy, Bhumika Aggarwal, Abhay Phansalkar and Peter Daley-Yates are GSK employees and hold GSK shares. Kyle Fahrbach and Amber Martin are employees of Evidera who provided statistical and intellectual support for this manuscript, funded by GSK. This article is based on a review of previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
| Funders | Funder number |
|---|---|
| Abbott | |
| AstraZeneca | |
| Boehringer Ingelheim | |
| GSK | |
| Novartis | |
| Pfizer | |
| Sanofi | |
| Sanofi-Aventis | |
| Sourabh Fulmali and Ebru Yildiz | |
| GlaxoSmithKline |
Keywords
- As-needed reliever
- Asthma management
- SABA
- Scientific evidence
- Short-acting β-agonists