SABA over-reliance; time for a change

areas. SABAs are given as the first line therapy, despite the fact that most asthma is related to Th2, often eosinophilic, inflammation that requires an anti-inflammatory such as inhaled corticosteroids (ICS)I to improve it.II The patients rely on their SABA often to the exclusion of the ICS, perceiving it as the medication giving them benefit. This leads to the paradox regarding the issue of patient autonomy. As patients control their own disease, in their mind, using SABA as they feel necessary, they then follow up with the clinician who recognizes that SABA use is a marker of disease activity and inflammation, so then changes the therapy, adding an anti-inflammatory to reduce the inflammation. These medications, however, are to be taken as per the clinician instructions and therefore all patient autonomy is removed from the decision process. Patients have clearly demonstrated that they want control over their own disease,III so this is going to be an issue for many. There is also often a disconnect between the patients understanding of asthma control, often feeling that means relief of their symptoms when they have them compared with the clinicians view on asthma control which means preventing symptoms, disability and exacerbations.