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Inhaled Corticosteroid/Beta-2-Agonist Reliever Therapy in Adolescents and Adults With Asthma

The importance of implementation of reliever-based regimens in adolescents and adults with asthma is emphasized in a commentary based on the Global Initiative for Asthma (GINA) 2023 standards. “In this era of evidence-based medicine, doctors need to not only be aware of the evidence of the efficacy and safety of the [inhaled corticosteroids (ICS)]/formoterol and ICS/albuterol reliever-based regimens, and the international guidelines recommending their use in the management of adolescents and adults with asthma, but also to ensure that they implement these reliever-based regimens in their clinical practice,” the authors advise.

Clinicians should consider several practical tips in incorporating GINA 2023 into their practices, the article recommends: “Ideally, ICS/beta2-agonist reliever-based regimens are implemented in clinical practice through the use of an asthma action plan. This approach provides a good structure to the consultation and facilitates the provision of information to guide the patient in their transition from a previous regimen.

“Second, ICS/beta2-agonist inhalers can be described to patients as a two-in-one inhaler, delivering both a reliever and a preventive medication, thereby treating both symptoms and the underlying disease process. Third, for the ICS/formoterol 6 μg/actuation inhalers, the reliever dose is always just one actuation on each occasion, rather than the standard two puffs from an albuterol 100 μg/actuation or ICS/albuterol 100 μg/actuation inhalers.

“Fourth, patients repeat the dose whenever required for relief of symptoms, recognizing that increasing use indicates worsening asthma control and the need to consider seeking urgent medical review. As with [short-acting beta agonist] therapy, use of ICS/formoterol or ICS/albuterol at least every 2 to 3 h can be suggested as a marker of severe asthma and the need for medical review, with this advice documented on the action plan. Fifth, ensure attention is given to instructing correct inhaler device use (and a check of the dose counter) at each visit, and to facilitate this, patients would be instructed to bring their inhalers to such visits.”

Source: Chest