Overview
Clinical Meaning
The foundation of asthma management separates controller therapy (daily anti inflammatory agents) from reliever therapy (rescue bronchodilators).
CNPLE
CNPLE
The foundation of asthma management separates controller therapy (daily anti-inflammatory agents) from reliever therapy (rescue bronchodilators). ICS is the cornerstone controller reducing airway inflammation, hyperresponsiveness, and remodeling. GINA 2024 introduced a paradigm shift: anti-inflammatory reliever (AIR) therapy with low-dose ICS-formoterol PRN replaces SABA-only rescue across all steps. This ensures every reliever dose delivers anti-inflammatory therapy, reducing the dissociation between symptom relief and inflammation control. The as-needed ICS-formoterol approach reduces severe exacerbations by 60% compared to SABA-only reliever. For patients on traditional fixed-dose ICS, SABA remains the reliever, but SABA overuse (> 3 canisters/year) is a marker of poor control and increased mortality risk. The clinician must understand these distinctions to prescribe appropriately.
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