Drop the SABA-only reliever. It’s not worth the risk

"I don't think any asthmatic in this world should have a SABA, ever." 

                                                                                                                —Dr. Paul O'Byrne

Is it asthma? Is it a cold? Will symptoms go away? Will they come back even worse? And how about an inhaler? Do we give one? Which one? And for how long?

Diagnosing and managing mild and moderate asthma can feel like a game of what-ifs. Worse, the treatment only works if patients stick with it, and that's hard when they feel fine.

On this episode of The Allergist, we speak with one of the world's leading authorities in asthma research. Dr. Paul O'Byrne is a professor of medicine at McMaster University whose landmark START and SYGMA trials reshaped how we think about treating mild asthma.

Key points:

• Our understanding of mild asthma has fundamentally shifted.
• SABA-only relief, used as needed, is riskier than we assumed.
• Daily inhaled steroids sharply cut the risk of severe exacerbations.
• But daily adherence is poor. People just don't take it consistently.
• The SYGMA trials were the breakthrough.
• An as-needed ICS-LABA reliever matched daily steroids, with far better uptake.
• More SABA use, more risk. More ICS-LABA use, less. Same reliever, opposite outcome.
• Ease patients in rather than fighting their SABA attachment.
• Most drop the SABA once they see the new approach working.

Getting the diagnosis right takes time but is critical because it's a potentially lifelong label. Keep patients off SABA alone, and make sure every reliever carries a steroid. Simple? Not quite, but a lot clearer.

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The Allergist is produced for CSACI by PodCraft Productions