"As-required" combination therapy with inhaled corticosteroids and long-acting beta-2 agonists for asthma: current evidence and recommendations.

Although both inhaled corticosteroids and beta-agonists have been the mainstay of inhaled pharmacotherapy in the management of asthma for many years, as "preventers" and "relievers", the advent of combination inhalers has prompted a revision of how these drugs ought to be used in practice. Studies to investigate their role, not only as regular treatment but also "as required" for relief of breakthrough symptoms, have recently been reported. The results are prompting a paradigm shift as to how inhaler therapy should be prescribed. In this review, the Executive of the Thoracic Society of Australia and New Zealand (New Zealand Branch) provide recommendations on maintenance and relief strategies based on currently available evidence. It is recognised that with further data these recommendations may require revision after three years.