As-Needed medication for asthma treatment: A paradigm shift?

The modern strategy for as-needed therapy in asthma has undergone a fundamental revision due to accumulating evidence of the risks associated with the overuse of short-acting β2-agonists (SABA). The paradigm has shifted from SABA monotherapy to the use of anti-inflammatory agents for symptom relief, such as fixed-dose combinations of inhaled corticosteroids (ICS) and bronchodilators. This review summarises the evidence for the effectiveness and safety of two key approaches: the single-inhaler Maintenance and Reliever Therapy (MART) regimen with ICS-formoterol and the use of an ICS-SABA combination (budesonide-salbutamol) exclusively for symptom relief. Analysis of the results of clinical trials demonstrates that both approaches significantly improve asthma control, reducing the risk of exacerbations and the need for systemic glucocorticoids, compared with SABA monotherapy. This strategy improves the effectiveness of anti-inflammatory therapy during periods of worsening symptoms, making it particularly useful for preventing exacerbations. The use of combination drugs containing ICS for asthma symptom relief is now considered a preferred strategy by international experts. According to the latest Global Initiative for Asthma (GINA) guidelines, as-needed ICS-formoterol therapy is preferred at Steps 1–2, while the MART regimen is applied at Steps 3–5. The ICS-SABA combination represents an alternative option for symptom relief starting from Step 1. Thus, modern as-needed therapy provides new possibilities for the effective and safe management of asthma, reducing the risks associated with SABA use and enhancing long-term disease outcomes.

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