I have been receiving questions on occasion regarding asthma therapy. More specifically, with the GINA recommendations, should SABA ever be used in asthma? Many are confused about what we should be doing for acute asthma relief. In my opinion, this confusion comes about from years of being taught that inhaled corticosteroids should NOT be used on a PRN basis. I remember this being a point of emphasis in school (way too many years ago)!

The Global Initiative For Asthma (GINA) has really blown that out of the water with its recommendation that inhaled corticosteroids should be used when a patient is having an acute exacerbation. Of course, they should be used in combination with a beta-agonist which is going to acutely open the airway.

What also confuses individuals is that we can use a long-acting beta-agonist (LABA) for acute relief. This is a bit of an oxymoron as when you think about using a “long-acting” medication, you generally do not anticipate short-term relief to happen. We should almost try to reclassify beta-agonists as rapid-acting or delayed-acting to help determine whether they will be helpful in acute relief.

Formoterol is technically a “LABA” according to its longer half-life but works very rapidly and can be useful in acute relief of asthma symptoms. The GINA guidelines prefer the combination of formoterol and budesonide PRN for acute relief. It comes as a combination in one inhaler (Symbicort). You would NOT use Symbicort PRN with albuterol PRN.

In patients who need an alternative to Symbicort (usually because of cost/insurance issues), the GINA report recommends SABA (i.e. albuterol) as an alternative in combination with an inhaled corticosteroid. Patients should not be taking both a SABA (i.e. albuterol) with formoterol as needed for acute relief.

Now, back to my original question. Should SABA Ever Be Used in Asthma? It can be used as an alternative, but GINA recommendations do not require that it be used at all. There is a really helpful table laid out in this link. Look for figure 2 of 6 a bit down the page where shows the various steps of asthma management.

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