Anti-inflammatory reliever therapy outperforms SABA-only in asthma management

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Frontiers in Medicine Published June 2, 2026 Medically reviewed June 2, 2026 Study authors: Neil Skolnik, Jessica Stieritz, Julie Akers, Timothy Hudd, Wendy L. Wright, Ileen Gilbert, Nazrin Yu… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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.

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.