The Role of ICS-Containing Rescue Therapy Versus SABA Alone in Asthma Management Today

The Global Initiative for Asthma (GINA) recommends that shortacting b2-agonist (SABA) monotherapy should no longer be prescribed, and that as-needed combination inhaled corticosteroids (ICS)eformoterol is the preferred reliever therapy in adults and adolescents with mild asthma. These recommendations are based on the risks of SABA monotherapy, the evidence that ICS-formoterol reliever therapy markedly decreases the occurrence of severe asthma exacerbations compared with SABA reliever therapy alone, and because ICS-formoterol reliever therapy has a favorable risk/bene fi t pro fi le compared with maintenance ICS plus SABA reliever therapy. Data supporting the use of combination ICS-albuterol reliever therapy in mild asthma are more limited, but there are studies that inform its use in this population. In this review, we compare, using a pros and cons format, the (1) long -term safety and eff i cacy of ICS-formoterol reliever therapy versus SABA reliever therapy alone, (2) long -term safety and ef ficacy of ICS-albuterol reliever therapy versus SABA reliever therapy alone, (3) immediate bronchodilator effects of ICS-formoterol versus SABA alone, and (4) clinical and regulatory factors that may inform reliever therapy prescription decisions. By presenting the evidence of these reliever inhaler options, we hope to inform the reader while also calling for necessary future effectiveness and imple- mentation research. (c) 2024 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2024;12:870-9)