The further paradoxes of asthma management: time for a new approach across the spectrum of asthma severity

Should short-acting β-agonist (SABA) reliever monotherapy be replaced by combination inhaled corticosteroid (ICS)/fast-onset β-agonist as reliever therapy in asthma patients at Global Initiative for Asthma step 1 [1]? This uncertainty is the latest chapter in the controversy relating to the risks and benefits of β-agonist therapy in asthma management [2]. This 70-year controversy began with the introduction of isoprenaline and the concerns that it caused severe refractory asthma and an increased risk of death [3–5]. A paradigm shift in asthma management that addresses the paradoxes of SABA reliever therapy is required; consideration needs to be given to replacement of SABA reliever with ICS/fast-onset β-agonist reliever therapy across the range of asthma severity http://ow.ly/ccff30lNLPv