Work

Anti-Inflammatory Reliever (AIR) Therapy: A Qualitative Study of What Matters to Patients with Asthma

Year: 2026

Type: article

Abstract: Background Anti-inflammatory reliever (AIR) therapy with as-needed budesonide–formoterol reduces exacerbation risk compared with short-acting β-agonist (SABA) monotherapy and is recommended for adolescents and adults with mild asthma. Despite guideline endorsement, AIR remains underused in the United States. Research Question What patient-level factors influence the use and acceptance of as-needed budesonide–formoterol AIR therapy in the United States? Study Design and Methods We conducted in-depth semistructured interviews with adults aged 18–75 years with mild asthma who completed a 24-week pragmatic randomized trial of AIR or maintenance therapy plus SABA. All trial completers were invited to participate. Interviews, guided by the Consolidated Framework for Implementation Research (CFIR), explored perceptions of AIR, treatment preferences, and factors influencing inhaler use. Transcripts were analyzed using a hybrid inductive–deductive thematic approach informed by CFIR. Results Among 33 participants, most perceived AIR favorably. Four themes emerged: (1) AIR was perceived as simpler and more intuitive because it consolidated treatment into a single, symptom-driven inhaler; (2) insurance coverage and out-of-pocket cost often superseded treatment preferences; (3) uncertainty about symptom control and cumulative inhaled corticosteroid exposure reduced confidence in AIR; and (4) transparent clinician communication, particularly regarding off-label use of budesonide–formoterol as a reliever, was important for maintaining trust. Interpretation AIR was perceived as convenient and consistent with most patients' preference for symptom-driven treatment. However, financial barriers and concerns about symptom control and corticosteroid exposure may limit uptake. Addressing cost, formulary access, and patient concerns may support broader AIR implementation.

Source: CHEST Pulmonary

DOI: 10.1016/j.chpulm.2026.100308