In the recent Asthma module, Info point 30 stated that SABA use before exercise counts towards the weekly rescue dose and may indicate a need for treatment escalation.
PBLP members have commented that the 2025 guideline from the Global Initiative for Asthma (GINA) contradicts this advice. GINA recommends that “In general, do not include reliever taken before exercise, because some people take this routinely without knowing whether they need it.”1
Although the 2021 guideline from the Canadian Thoracic Society (CTS) did not comment on this issue,2 the 2010 CTS iteration took a different approach, stating “Regular need for a reliever to prevent or treat exercise-induced symptoms indicates suboptimal control and should be included in the weekly limit.”3 Furthermore, a 2024 Asthma Overview from RxFiles also recommends including pre-exercise SABA when assessing asthma control.4
Guidelines often contradict each other and, when possible, we rely on Canadian guidelines. We feel, however, it is important for members to know where guidelines do not concur so they can make their own informed decisions.
Reference List
- Global Initiative for Asthma. Global strategy for asthma prevention and management. Updated May 2025. 2025. ginasthma.org
- Yang CL, Hicks EA, Mitchell P, al e. Canadian Thoracic Society 2021 Guideline update: diagnosis and management of asthma in preschoolers, children, and adults. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. 2021;5:348-61.
- Lougheed MD, Lemiere C, Dell SD, et al. Canadian Thoracic Society Asthma Management Continuum—2010 Consensus Summary for children six years of age and over, and adults. Can Respir J. 2010;17:15-24. https://doi.org/10.1155/2010/827281
- Crawley A, Jensen B, Jin M, al e. Asthma: Overview. 2024. RxFiles. www.rxfiles.ca.