What are the guidelines for asthma management?

From the Guidelines

Effective asthma management requires a comprehensive approach combining medication, lifestyle modifications, and regular monitoring, with the goal of achieving and maintaining good asthma control over time, as emphasized by the National Asthma Education and Prevention Program guidelines 1. The cornerstone of treatment involves two main medication types:

• Quick-relief medications (rescue inhalers) like albuterol (2 puffs every 4-6 hours as needed)
• Controller medications such as inhaled corticosteroids (like fluticasone 88-220 mcg twice daily or budesonide 180-360 mcg twice daily) 1. For moderate to severe asthma, combination inhalers containing both a corticosteroid and a long-acting beta-agonist (like fluticasone/salmeterol or budesonide/formoterol) are often prescribed 1. Patients should develop an asthma action plan with their healthcare provider, detailing how to adjust medications during symptom changes, and environmental trigger avoidance is crucial, including minimizing exposure to allergens, irritants, and maintaining good indoor air quality 1. Regular follow-up appointments (typically every 3-6 months for stable asthma) allow for treatment adjustments based on symptom control, and proper inhaler technique is essential for medication effectiveness; spacers may improve delivery for metered-dose inhalers 1. These approaches work together to reduce airway inflammation and bronchospasm, the underlying mechanisms of asthma symptoms, ultimately preventing exacerbations and maintaining optimal lung function. Key aspects of asthma management include:
• Assessing and achieving good asthma control through regular monitoring and adjustments to treatment plans
• Educating patients on proper inhaler technique and the importance of adherence to prescribed medications
• Encouraging environmental trigger avoidance and lifestyle modifications to reduce asthma symptoms
• Developing a personalized asthma action plan to guide adjustments to medications during symptom changes.

From the FDA Drug Label

1.1 Maintenance Treatment of Asthma 2.1 Dosing Recommendations 17.3 Not for Acute Symptoms

Asthma Management: Budesonide (INH) is indicated for the maintenance treatment of asthma 2. It is not intended for acute symptoms. The dosing recommendations should be followed as outlined in the label.

From the Research

Asthma Management Overview

• Asthma management has undergone significant changes in recent years, with a shift away from traditional treatments such as short-acting beta agonists (SABAs) 3.
• The Global Initiative for Asthma 2019 strategy recommends the use of combined inhaled corticosteroid-fast acting beta agonist as a reliever, rather than SABAs, due to safety concerns and poor outcomes 3.

Inhaled Corticosteroids and Long-Acting Beta Agonists

• Fixed-dose combinations of inhaled corticosteroids (ICSs) and long-acting beta2-agonists (LABAs) are recommended for the treatment of persistent asthma 4, 5.
• Studies have shown that ICS/LABA combinations can provide 24-hour improvement in lung function in adult asthmatic patients 4.
• The choice of ICS and LABA can affect the efficacy of treatment, with some combinations showing greater improvements in lung function and symptom control than others 6.

Real-World Evidence

• A retrospective matched cohort study found that treatment with fluticasone furoate/vilanterol (FF/VI) was associated with lower use of short-acting beta2-agonist (SABA) canisters and fewer asthma-related exacerbations compared to budesonide/formoterol (B/F) 7.
• The study suggests that once-daily FF/VI may provide better asthma control than twice-daily B/F in real-world practice 7.

Treatment Outcomes

• Treatment outcomes for asthma management include lung function, symptom-free days, use of rescue/reliever medications, asthma exacerbations, and tolerability profile 6.
• Studies have shown that ICS/LABA combinations can improve lung function, reduce symptoms, and decrease the use of rescue medications 4, 6.
• The choice of treatment can affect the risk of asthma exacerbations, with some combinations showing a lower risk of severe exacerbations than others 7.