From the Guidelines
Asthma management should follow a stepwise approach based on symptom severity and control, with the goal of achieving well-controlled asthma, as recommended by the most recent guidelines 1.
Key Principles of Asthma Management
- The stepwise approach involves progressively increasing treatment to achieve asthma symptom control and reduce the risk of exacerbations.
- Treatment should be individualized based on the level of asthma control, with the option to reduce the dose after a period of prolonged control.
- The assessment of asthma control should include symptoms, sleep disturbance, use of rescue medication, limitations of daily activity, patient and physician overall assessment, and lung function 2.
Medication Recommendations
- For mild intermittent asthma, short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are recommended.
- For persistent asthma, low-dose inhaled corticosteroids (ICS) such as fluticasone (100-250 mcg twice daily) or budesonide (180-360 mcg twice daily) are the preferred initial controller therapy.
- If symptoms persist, add a long-acting beta-agonist (LABA) like salmeterol or formoterol, often available in combination inhalers with ICS.
- For moderate-to-severe asthma, higher-dose ICS-LABA combinations may be needed, potentially supplemented with leukotriene modifiers (montelukast 10mg daily for adults) or long-acting muscarinic antagonists (tiotropium 2.5 mcg daily) 3, 4.
Importance of Asthma Action Plan
- All patients should have an asthma action plan detailing medication adjustments based on symptom changes, proper inhaler technique instruction, and regular follow-ups to assess control.
- The asthma action plan should be tailored to each patient's individual needs and should include strategies for managing asthma exacerbations.
- Regular follow-ups with a healthcare provider are essential to assess asthma control and adjust treatment as needed 2, 3.
From the FDA Drug Label
1.1 Treatment of Asthma 2.1 Asthma 5.1 Serious Asthma-Related Events – Hospitalizations, Intubations, Death 5.2 Deterioration of Disease and Acute Episodes 6.1 Clinical Trials Experience in Asthma 14.1 Asthma
The asthma guidelines are not explicitly stated in the provided drug label. However, the label does provide information on the treatment of asthma, including dosage and administration, warnings and precautions, and clinical trials experience.
- Treatment of Asthma: The drug is indicated for the treatment of asthma.
- Dosage and Administration: The label provides guidance on dosage and administration for asthma patients.
- Warnings and Precautions: The label highlights the risk of serious asthma-related events, deterioration of disease, and acute episodes.
- Clinical Trials Experience: The label summarizes the clinical trials experience in asthma patients. 5
From the Research
Asthma Guidelines Overview
- Asthma management requires a stepwise approach, escalating and de-escalating treatment based on symptom control, as recommended by the 2019 Global Initiative for Asthma (GINA) guidelines 6
- The current therapeutic stepping approach to asthma considers lung function, symptoms, and quality of life, but may not account for underlying mechanisms and individual patient needs 7
Treatment Options
- Inhaled corticosteroids (ICSs) and long-acting inhaled beta(2)-agonists (LABAs) are recommended treatment options for asthma, with combination therapies often providing greater improvements in outcomes than monotherapies 8
- Fluticasone propionate and formoterol fumarate have been associated with improved therapeutic benefits compared to budesonide and salmeterol, respectively 8
- Salmeterol/fluticasone propionate combination therapy has been shown to be effective in improving lung function and symptoms, and is a cost-effective option for maintenance treatment of asthma 9
Symptom Control and Exacerbations
- Treatment with fluticasone furoate/vilanterol (FF/VI) has been associated with reduced risk of severe asthma exacerbations and improved lung function and symptom control compared to budesonide/formoterol (B/F) 10
- The use of FF/VI has been shown to result in lower use of short-acting β2-agonist (SABA) canisters and fewer asthma-related exacerbations compared to B/F 10
Individualized Treatment Approach
- A pragmatic approach to asthma management, setting therapeutic goals for each individual and associating them with treatable traits of asthma, may be more effective than the current stepping approach 7
- Patient-specific factors, such as overestimation or underestimation of disease severity, and differences in opinions between patients and physicians, should be considered when developing treatment plans 7