The evolution of asthma therapy: from symptom relief to disease control and reducing the risk of exacerbations

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Abstract

Bronchial asthma (BA) remains a common chronic disease with poor control in a significant proportion of patients, associated with a high risk of exacerbations and mortality. The excessive use of short-acting β₂-agonists (SABA) is one of the modifiable factors for poor asthma control. The use of SABA without an anti-inflammatory component creates an illusion of well-being, contributing to the progression of airway inflammation, which is accompanied by decreased control, increased asthma exacerbation frequency, and the risk of death. Recognition of these risks has led to a fundamental revision of asthma management strategies, abandoning SABA monotherapy and requiring the use of inhaled glucocorticosteroids for symptom relief. The logical conclusion of this evolution was the development of a new fixed-dose combination of budesonide and salbutamol, which combines rapid symptom relief with anti-inflammatory action. A systematic search was conducted in the PubMed, Web of Science, and Medline electronic databases. The efficacy of budesonide/salbutamol was confirmed in the MANDALA and BATURA studies, which demonstrated a significant reduction in the risk of severe exacerbations and systemic steroid load in patients with varying asthma severity. Data from the TYREE study confirm the protective effect of the combination against exercise-induced bronchoconstriction. Thus, the fixed-dose combination of budesonide/salbutamol represents a new standard of symptom-oriented therapy, providing a comprehensive approach to disease control and reducing the risk of exacerbations.

About the authors

I. N. Trofimenko

Irkutsk State Medical Academy of Postgraduate Education – Branch of the Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: tin11@mail.ru
ORCID iD: 0009-0000-0995-6146
SPIN-code: 9345-4572

Dr. Sci. (Med.), Associate Professor, Head of the Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

S. N. Buynova

Irkutsk State Medical Academy of Postgraduate Education – Branch of the Russian Medical Academy of Continuous Professional Education

Email: 33s1@rambler.ru
ORCID iD: 0000-0002-2603-0051
SPIN-code: 9202-8700

Cand. Sci. (Med.), Associate Professor, Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

A. F. Ivanov

Irkutsk State Medical Academy of Postgraduate Education – Branch of the Russian Medical Academy of Continuous Professional Education

Email: afivanov@rambler.ru
ORCID iD: 0000-0003-3702-9635
SPIN-code: 6989-7922

Cand. Sci. (Med.), Associate Professor, Department of Clinical Allergology and Pulmonology

Russian Federation, Irkutsk

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