SABAs as Reliever Medications in Asthma Management: Evidence-Based Science

Abstract

The role of as-needed inhaled short-acting β 2 -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.

Effect of Individual Patient Characteristics and Treatment Choices on Reliever Medication Use in Moderate-Severe Asthma: A Poisson Analysis of Randomised Clinical Trials

“…Despite the importance of maintenance therapy, a significant proportion of patients seems to rely on reliever to manage worsening of asthma symptoms. Indeed, a debate has been ongoing on the effect of variable adherence to maintenance therapy and implications of over-reliance on the effects of reliever medication in moderate-severe asthma, in particular short-acting beta-adrenergic agonists (SABA) [ 29 , 30 ]. Whilst multiple factors may contribute to such a behaviour, there have been limited efforts to assess the interplay among reliever use, symptom control and future risk using longitudinal data.…”