Asthma

Prescribing SABA alone in adults with asthma ‘negligent’ says leading expert


Prescribing a single agent SABA inhaler to adults with asthma should be considered negligent, a leading respiratory physician has said.

Professor Andy Bush from the Royal Brompton in London was responding to a recent study that found the use of a combined formoterol-budesonide inhaler, taken as needed to relieve symptoms, reduced the risk of asthma exacerbations by 50% compared with salbutamol alone.

The study by Professor Richard Beasley, a Wellington respiratory physician and Director of the Medical Research Institute of New Zealand, and colleagues concluded that the results provided new evidence supporting changes in asthma treatment guidelines to favour the use of a single inhaler therapy of LABA-ICS over SABA [read our coverage here].

“The trial shows for the first time that when patients take just a single combined preventer-reliever inhaler whenever needed to relieve symptoms, they do a lot better than the current recommended treatment of a regular preventer inhaler taken twice daily plus a reliever inhaler whenever needed to relieve symptoms,” Professor Beasley said.

According to Professor Bush the study added to mounting evidence that intermittent, as-needed regimens were more effective than conventional regimens based on regular ICS, which have poor adherence.

SABA should cease to be prescribed for eosinophilic airway disease at least in adults, a move that would necessitate an immediate and radical revision of guidelines, he advised in a comment published in Lancet Respiratory Medicine.

“It is, unfortunately, impractical to take SABA as a single agent off the market altogether, given that ICS might not be indicated in some airway diseases at the extremes of age, namely non-atopic wheeze in children younger than 5 years, and chronic obstructive pulmonary disease.. [but] it should be considered negligent to prescribe SABA to adults in any other context,” he wrote.

Prof. Bush called on the medical community to reflect on their mistakes, noting that as a so-called therapeutic community “we have been guilty of uncritically repeating guidelines for far too long”.

“In the words of Bertie Wooster, “Jeeves, this nuisance must now cease!” he concluded.

However,  in a major change to the management of patients with mild asthma, the Global Initiative for Asthma (GINA) recently recommended against starting any patients with asthma on short-acting β2 agonist (SABA) relievers alone.

Instead, its latest guidelines recommend that all adults and adolescents from 12 years are treated with a “more equal focus on symptom relief and preventing severe exacerbations and potential deaths.”

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