From the Guidelines
The GINA guidelines support the intermittent use of inhaled steroids, specifically recommending as-needed low-dose inhaled corticosteroid-formoterol (ICS-formoterol) for adults and adolescents with mild asthma. This approach is based on the principle of using a combination inhaler containing both a low-dose inhaled corticosteroid and formoterol (a fast-acting long-acting beta-agonist) only when symptoms occur, rather than daily. According to the 2020 focused updates to the asthma management guidelines 1, in individuals aged 12 years and older with mild persistent asthma, the Expert Panel conditionally recommends either daily low-dose ICS and as needed SABA for quick-relief therapy or as-needed ICS and SABA used concomitantly. Some key points to consider when implementing this approach include:
- Using a combination inhaler containing both a low-dose inhaled corticosteroid and formoterol, such as budesonide-formoterol (Symbicort) or beclomethasone-formoterol (Foster)
- The typical as-needed dosing is 1-2 inhalations when experiencing symptoms, with a maximum of 8 inhalations per day for adults (4 inhalations per day for adolescents)
- This intermittent approach addresses both airway inflammation and bronchoconstriction simultaneously when symptoms occur, providing anti-inflammatory treatment and quick symptom relief
- The anti-inflammatory effect of the ICS component helps prevent severe exacerbations, while the formoterol provides quick symptom relief, as supported by the conditional recommendation with moderate certainty of evidence from the 2020 guidelines 1.
From the Research
GINA Guidelines for Intermittent Use of Inhaled Steroids
- The Global Initiative for Asthma (GINA) guidelines recommend that all asthma patients be treated with inhaled corticosteroids (ICS) taken daily or as needed, which improves symptoms and outcomes, even in those with mild disease 2, 3.
- For adults and adolescents with mild asthma, GINA experts recommend either symptom-driven or daily low-dose ICS, with the main goal of reducing the risk of serious asthma exacerbations and asthma-related deaths 2.
- The 2019 GINA guidelines suggest a stepwise approach to asthma management, escalating and de-escalating treatment based on symptom control 3.
- Inhaled corticosteroids are the mainstay of asthma treatment, and adding a long-acting beta2-agonist (LABA) to ICS appears more efficacious than adding a short-acting beta2-agonist or an antileukotriene 4.
- Combined ICS and LABA inhalers are an efficacious, safe, and practical approach for asthmatic patients who are not well-controlled with low doses of ICS alone 4, 5, 6.
- Factors such as age, obesity, and smoking can negatively affect disease control, but combined ICS/LABA inhalers may reduce their effect 5.