Abstract
BackgroundThe treatment with short-acting beta-2 agonists (SABA) alone is no longer recommended due to safety issues. Instead, the current Global Initiative for Asthma (GINA) Report recommends the use of the combination of inhaled corticosteroids (ICS) with the rapid/long-acting beta-2 agonist formoterol, although the use in steps 1 and 2 is still off-label in the EU and in many countries. It is important to understand clinicians’ knowledge and opinions on the issue with the ultimate goal to encourage the implementation of the new approach in clinical practice.MethodsWe performed an international survey, directed to pulmonologists interested in the management of patients with asthma.ResultsMost participants reported that SABA alone should not be used in GINA Step 1 asthma treatment. As-needed low-dose ICS/formoterol combination to patients in step 1, and as-needed low-dose ICS/formoterol as reliever therapy in any step were found to be of current use prescribed in their real-life settings. SABA alone was still prescribed to a proportion of patients, although the pulmonologists’ opinion was that it should no longer be used.ConclusionsMost specialists are up to date and understand the relevance of the changes in GINA reports from 2019. Nevertheless, dissemination and implementation of GINA novel management strategy is still needed.
Highlights
The treatment with short-acting beta-2 agonists (SABA) alone is no longer recommended due to safety issues
In line with the same concept of including an inhaled corticosteroids (ICS) in the rescue medication, another major change that was introduced in 2019 is that reliever therapy with asneeded low-dose ICS/formoterol is recommended as the preferred rescue option for any asthma step, except when patients are using another ICS–long-acting beta-2 agonist combination as a controller [2]
The three-way SYGMA 1 trial included patients on Global Initiative for Asthma (GINA) step 2 treatment and indicated that as-needed budesonide–formoterol combination was superior to as-needed SABA and provided a non-inferior effect on annual rate of exacerbation reduction, with a lower exposure to ICSs, when compared to a maintenance ICS regimen [6]
Summary
The treatment with short-acting beta-2 agonists (SABA) alone is no longer recommended due to safety issues. In line with the same concept of including an ICS in the rescue medication, another major change that was introduced in 2019 is that reliever therapy with asneeded low-dose ICS/formoterol is recommended as the preferred rescue option for any asthma step, except when patients are using another ICS–long-acting beta-2 agonist combination as a controller [2]. Evidence for these recommendations was produced by large randomized controlled trials and by real-world studies. The results of SYGMA 2 trial, including the same patient population, indicated noninferiority of the as-needed budesonide–formoterol combination compared to the maintenance ICS plus asneeded SABA regimen in reducing the exacerbation rate in patients with mild asthma [7]
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