Family Physician Airways Group of Canada, Canada
Dr Alan Kaplan is a Family Physician working in York Region, Ontario, Canada and the Chairperson of the Family Physician Airways Group of Canada (www.fpagc.com), the Past- Chairperson of the Respiratory Section of the College of Family Physicians of Canada, and Senate member of the International Primary Care Respiratory Group. He co-chaired the Community Standards of COPD program for Health Quality Ontario. He is the medical director of the Pulmonary Rehabilitation program for the local health integration network
Despite advances in Asthma management, we still have remarkable levels of poor control, asthma exacerbations and even death. We need to rethink how we approach Asthma and the recent Lancet commission on Asthma has supported this[i]. Basic issues such as inhaler technique and adherence[ii] continue to be major issues.
Dr. O'Byrne and all have recently written a paper[iii] on the Paradoxes of Asthma management, which highlights some of the common issues which include:
a) SABA (short acting beta agonist) as foundation/initial therapy
b) overuse of LABAs a concern, but SABAS are not?
c) poor patient self control in GINA stage > 2
d) asthma is an inflammatory disease, so why do we rely so on bronchodilators
e) patients and clinicians do not agree on what 'Asthma Control' means to them.
As adherence to the key treatment, inhale corticosteroids (ICS)is often low, solutions to the adherence issue are needed. One of the solutions, is to work with the patient's own behaviors to improve adherence. As such, using an Anti-inflammatory reliever rather than a SABA to ensure the that ICS are used.
There is a great deal of data on inhaled budesonide/formoterol as controller and reliever in GINA stages 3-4, and now there is evidence in stages 1 and 2 as well[iv],[v]. This will be reviewed and you will rethink how you use reliever therapy in Asthma, even in mild cases!