Position statement: asthma in Latin America. IS short-acting beta-2 agonist helping or compromising asthma management?

Abstract

In Latin-America, with 603 million inhabitants, the average prevalence of asthma is estimated at 17%, but with wide fluctuations, ranging from 5% in some cities (Mexico) to 30% in Costa Rica. The risk of severe exacerbations seems to be higher in Latin America compared with other regions. A majority of patients uses daily quick-relief medication, with the belief that it is the most important treatment because of its rapid onset of action; without treating the underlying inflammation. Overuse of short-acting beta₂ agonists (SABAs) is associated with increased risk of asthma deaths in a dose–response manner. Beta₂ agonists increase the severity of asthma through enhanced bronchial hyperresponsiveness and reduced lung function. Also, it has been shown that overreliance on SABA delays recognition of a potentially life-threatening asthma attack. We believe that overreliance on SABA in asthma is also an important public health issue. The fact that SABA use in GINA is not supported by a randomized trial but by an anonymous paper; makes us guess that we use SABA just because we are used to do so. In 2019 GINA strategy introduces one of the most important changes in the management of Asthma in the past 30 years, highlighting anti-inflammatory reliever therapy. A combination of low dose ICS/fast action bronchodilator will not only treat symptoms, but more importantly the underlying inflammation, protecting patients from preventable asthma attacks. After 50 years of a SABA centric approach in asthma management, it is time to leave behind a treatment based just on the bronchodilation and tackle the inflammation.

Keywords:

• Asthma
• short acting beta agonist bronchodilators

Acknowledgments

The expert discussion meeting organization was supported by Astrazeneca.

Declaration of interest

LJN: personal fees as speaker for AstraZeneca and for Advisory boards from AstraZeneca and Sanofi-Genzime Argentina outside the submitted document. SL: personals fees from Astrazeneca outside the submitted work. RAR: personal fees from GlaxoSmithKline and AstraZeneca Argentina. MA: payment for services to AstraZeneca and Teva outside the submitted work. JLM: personals fees from Astrazeneca, GlaxoSmithKline, Boehringer Ingelheim and Novartis outside the submitted work. CC: personals fees from Astrazeneca, GlaxoSmithKline, Boehringer Ingelheim, Moksha 8 and Novartis outside the submitted work. RS: sponsorship bonds for participation in clinical studies, conferences or consultancy activities, with the following pharmaceutical companies.: Astra Zeneca, Boehringer Ingelheim, Chiesi, Eurofarma, GlaxoSmithKline, MSD, Novartis and Reckit Beckinser, outside the submitted work.