Answer:

Mild asthma often leads to complacency. When only occasionally experiencing coughing, wheezing, or shortness of breath, patients might believe that regular control treatment is unnecessary, and they only need medication during an attack. However, even with infrequent symptoms, chronic airway inflammation persists. This means patients can still experience severe exacerbations, even life-threatening ones.

Since 2019, the Global Initiative for Asthma (GINA) strategy, with its latest update in 2026, has not recommended treating asthma in adults and adolescents solely with short-acting beta 2-agonist (SABA) reliever medications. SABA only dilates the bronchi, providing temporary symptom relief without addressing the underlying airway inflammation. Relying solely on SABA for symptom relief without maintenance asthma medication can cause airway inflammation to persist, increasing the risk of severe exacerbations and asthma-related death.

Instead, GINA recommends that all asthma patients from adolescence onwards need treatment with inhaled corticosteroids (ICS). This group of anti-inflammatory airway medications helps reduce the risk of acute asthma attacks. Depending on the severity, ICS can be used as needed or regularly daily. Those prescribed maintenance treatment must use the correct dose, for the sufficient duration, and consistently, even when symptoms have decreased.

Doctor Ngan advises a patient. Illustration: Tam Anh General Hospital

However, not all mild asthma sufferers must use fixed daily control medication. For adults and adolescents whose symptoms do not occur daily, who do not wake up at night due to asthma (meaning, less than once a week), and whose lung function is normal or only slightly reduced, the preferred option is low-dose ICS-formoterol, used as needed. ICS-formoterol combines inhaled corticosteroids (ICS), which control airway inflammation, and formoterol – an active ingredient from the long-acting bronchodilator group that has a rapid onset similar to SABA. Thus, each time symptoms appear and medication is needed, the patient receives both bronchodilation and anti-inflammatory effects.

The 2023 guidelines from the European Respiratory Society (ERS) also recommend that adults and adolescents with mild asthma should use ICS-formoterol instead of SABA as needed. According to ERS, patients can choose this method instead of daily maintenance ICS combined with SABA as needed.

In locations where ICS-formoterol is not yet available, GINA 2026 also adds the option of anti-inflammatory reliever therapy combining ICS-SABA right from the first treatment step. Alternatively, patients can use low-dose daily maintenance ICS with SABA as needed, but should not use SABA alone.

Whether using daily control medication or ICS-formoterol as needed according to prescription, patients should not arbitrarily change or stop treatment when their condition seems stable. If asthma is well-controlled for about 2-3 months, a doctor may assess the possibility of stepping down treatment. Stepping down needs to be planned and does not mean the patient can unilaterally stop all ICS-containing medications.

Therefore, patients should not choose medication solely based on how frequently symptoms appear. A doctor needs to comprehensively assess the level of asthma control, risk of exacerbations, lung function, inhaler technique, and treatment adherence to select the appropriate regimen for each individual.

Master, Doctor Nguyen Van Ngan

Department of Respiratory Medicine

Tam Anh Cau Giay General Clinic