Summary:
Until 2019, SABA were the preferred rescue medications and were recommended for monotherapy in the first stage of asthma treatment. It should be added that a significant percentage of patients with newly diagnosed asthma started their asthma treatment with SABA monotherapy and unfortunately continued it even when the symptoms increased. In 2007, Dusser et al. published a meta-analysis showing that patients suffering from mild asthma quite often experience severe exacerbations with a frequency of 0.12 to 0.77 per patient per year. Severe exacerbations in mild asthma make up 30‒40% of asthma exacerbations requiring consultation in hospital emergency departments. Even patients with mild symptoms (0 to 1‒2 times a week) meeting the criteria for GINA-controlled asthma are at risk of severe life-threatening exacerbations (near fatal asthma). They constitute over 70% of patients treated for acute asthma attacks in emergency departments. Post hoc analysis of the results of the START study showed that the use of low-dose wGKS (BUD 200‒400 μg/day) in such patients (symptoms 0‒1 times a week) reduces the risk of exacerbation of the disease by half compared to patients using SABA alone, and reduces demand for oral GKS. It was shown 20 years ago that a low dose of iGKS reduced the risk of sudden death from asthma. Studies indicate that the use of GKS/FORM symptomatically at stages 1 and 2 together with SMART therapy from the third to the fifth stage in asthma management, create the most personalized asthma therapy we know. Its effect is independent of the asthma phenotype and endotype, and the ICS dose is best adapted to the current course of asthma. SABAs can be added to treatment in patients who are using daily inhaled steroids alone in the second stage and in the third to fifth grades in patients taking a higher dose of GKS or GKS with delay and long-acting mechanism of action.
Keywords: asthma, SABA, GKS, GINA, SMART/MART
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