Editorial comment on: Short‐acting β 2‐agonist use and asthma exacerbations in Swedish children: A SABINA Junior study

Abstract

Asthma is one of the most common chronic lung diseases with major public health consequences for both children and adults, including high morbidity and even mortality. 1 For years, standard asthma treatment for mild asthma has been as-needed short-acting beta agonist (SABA). Global Initiative for Asthma (GINA) guidelines have questioned this approach suggesting that the use of SABAs should always be accompanied by inhaled corticosteroids (ICSs). 2 Recently, Papi et al. have shown that in adolescents and adults with uncontrolled moderate-to-severe asthma receiving inhaled glucocorticoid-containing maintenance therapies, the risk of severe asthma exacerbation was significantly lower with as-needed use of a fixed-dose combination of albuterol and budesonide than with as-needed use of albuterol alone . 3 In children, on the contrary, even though many years ago Martinez et al. have shown that inhaled corticosteroids as rescue medication with albuterol might be an effective step-down strategy for children aged 5-18 years with well-controlled mild asthma, SABA has remained to be the only reliever option recommended for those under 6 years of age. 4 This is mainly due to reservations to use ICS in children because of the potential systemic adverse effects of these drugs; though, these are dose-and time-dependent, and benefits may outweigh the risks.The SABA use IN Asthma (SABINA) program in adults and adolescents with asthma reported that SABA overuse (≥3 canisters/year) is prevalent in Sweden and is associated with poor asthma-related outcomes. 5 Melen et al and the SABINA Junior investigators have attempted to investigate the same question in the pediatric population. 6,7