Mode
Text Size
Log in / Sign up

Anti-inflammatory reliever therapy outperforms SABA-only in asthma managementDoctors suggest using anti-inflammatory reliever therapy for better asthma control and safety

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Consider transitioning patients from SABA-only to anti-inflammatory reliever therapy to reduce exacerbation risk.

This narrative review examines the role of anti-inflammatory reliever (AIR) therapy, including single maintenance and reliever therapy (SMART/MART), versus short-acting beta2-agonist (SABA)-only bronchodilators in asthma management. The authors synthesize evidence suggesting that AIR-based approaches, which combine a fast-acting bronchodilator (e.g., formoterol) with an inhaled corticosteroid (ICS), reduce the risk of severe exacerbations and improve overall asthma control compared to SABA-only regimens.

The review highlights that SMART/MART, where patients use a single inhaler containing both ICS and formoterol for maintenance and as needed for relief, simplifies treatment and aligns with current guideline recommendations. The authors argue that SABA-only therapy, while effective for acute symptom relief, does not address underlying airway inflammation and may lead to overuse and increased exacerbation risk.

As a narrative review, the article does not provide pooled effect sizes or systematic search methods. Limitations include potential selection bias in cited studies and lack of quantitative synthesis. The authors do not report specific adverse events or funding sources.

For clinicians, the review reinforces the shift away from SABA-only reliever strategies toward anti-inflammatory reliever approaches, particularly in patients with moderate to severe asthma. However, individual patient factors and access to combination inhalers should guide treatment decisions.

Asthma is a common condition that makes breathing difficult. Many people use medicine to open their airways and reduce swelling. This review examines different ways to manage this illness effectively. It focuses on two main approaches for daily treatment.

One method uses a short-acting bronchodilator alone. This is the traditional way many patients have used for years. Another method combines a bronchodilator with an anti-inflammatory medicine. This new approach is called single maintenance and reliever therapy. It aims to treat both symptoms and the underlying inflammation.

The review found that the combined approach might work better. Patients using this method often have fewer asthma attacks. They also experience better day-to-day breathing without needing extra rescue medicine. Safety data suggests this strategy is well tolerated by most people.

Doctors are starting to recommend this combined strategy more often. It helps keep asthma under control while reducing the need for emergency care. However, every patient is different. Your doctor can help choose the best plan for your specific needs.

What this means for you:
Combining anti-inflammatory medicine with a reliever may offer better asthma control and safety than using a bronchodilator alone.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
The Global Initiative for Asthma (GINA) report and national and international guidelines have shifted away from short-acting beta2-agonist (SABA)-only bronchodilators as first-line asthma rescue therapy, recognizing that both bronchoconstriction and inflammation underlie the increase in symptoms preceding an exacerbation. Instead, the GINA Committee supports strategies to reduce inflammation, such as anti-inflammatory reliever (AIR) therapy (as-needed, low-dose inhaled corticosteroid [ICS]–formoterol or SABA–ICS for symptom relief) and single maintenance and reliever therapy (SMART) or maintenance and reliever therapy (MART; i.e., ICS–formoterol used as both maintenance and as-needed rescue therapy). This narrative review discusses the rationale behind the move toward AIR and SMART regimens, examining the inflammatory pathophysiology of exacerbations and how the ramp-up phase may represent a “window of opportunity” for prompt anti-inflammatory treatment to prevent exacerbations. Key clinical data from studies of AIR and SMART regimens, as well as the importance of as-needed SABA–ICS use in routine clinical practice, are also discussed. The review highlights the importance of ICS delivery during times of wheezing and/or symptoms to reduce the ongoing inflammatory cascade, thereby reducing the likelihood of initial symptoms developing into an exacerbation. In this way, patients can avoid the need for systemic corticosteroids, reducing the overall lifetime steroid load and the risk of lifetime dose-dependent complications such as bone thinning, diabetes, hypertension, and many other conditions.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.