What is reactive airway disease?

From the Guidelines

Reactive airway disease should be treated with a short-acting b2-agonist before exercise in all patients, as this is a strong recommendation supported by high-quality evidence. This approach is based on the findings of a clinical practice guideline published in the American Journal of Respiratory and Critical Care Medicine 1. The guideline emphasizes the importance of using a short-acting b2-agonist before exercise to prevent symptoms of exercise-induced bronchoconstriction (EIB).

For patients who continue to experience symptoms despite the use of a short-acting b2-agonist, additional treatment options are recommended, including:

• A daily inhaled corticosteroid
• A daily leukotriene receptor antagonist
• A mast cell stabilizing agent before exercise These recommendations are also strongly supported by the evidence 1.

Key considerations in managing reactive airway disease include:

• Identifying and avoiding triggers that can exacerbate symptoms
• Using prescribed medications as directed, such as short-acting bronchodilators for quick relief during symptoms
• Seeking emergency care if symptoms worsen or do not improve with treatment
• Recognizing that reactive airway disease may be temporary and often follows respiratory infections, differing from diagnosed asthma in its potential for resolution.

From the Research

Reactive Airway Disease

• Asthma is a chronic disease characterized by inflammation and bronchoconstriction, and medications that can effectively treat both components are advantageous 2.
• The combination of an inhaled corticosteroid and a long-acting beta2-agonist, such as fluticasone propionate and salmeterol, provides greater asthma control than increasing the inhaled corticosteroid dose alone or adding a leukotriene modifier 3, 4.
• Studies have compared the efficacy of fluticasone propionate-salmeterol combination therapy with montelukast in patients with persistent asthma, and results show that the combination therapy is more effective in improving lung function, symptom control, and quality of life 2, 4, 5.
• The addition of salmeterol to fluticasone propionate has been shown to provide superior asthma control compared to the addition of montelukast, with significant improvements in morning predose forced expiratory volume, peak expiratory flow rate, and symptom-free days 2, 4.
• However, one study found that the addition of montelukast to fluticasone propionate could provide equivalent clinical control to salmeterol in patients whose symptoms remain uncontrolled by inhaled fluticasone alone 6.

Treatment Options

• Fluticasone propionate-salmeterol combination therapy is a effective treatment option for patients with persistent asthma, providing greater improvements in lung function and symptom control compared to montelukast 2, 4.
• Salmeterol and fluticasone propionate have been shown to have complementary actions, with salmeterol activating the glucocorticoid receptor and enhancing the anti-inflammatory effects of fluticasone propionate 3.
• Montelukast may be a suitable alternative for patients who do not respond to or cannot tolerate inhaled corticosteroids or long-acting beta2-agonists, with studies showing equivalent clinical control to salmeterol in some patients 6.

Airway Inflammation

• Airway inflammation is a key component of asthma, and treatments that can effectively reduce inflammation are crucial for achieving asthma control 2, 5.
• Studies have shown that fluticasone propionate-salmeterol combination therapy can reduce airway inflammation, with significant improvements in sputum inflammatory markers and airway responsiveness 5.
• However, the effects of different treatments on airway inflammation can vary, with some studies showing that montelukast may have anti-inflammatory effects, particularly in reducing peripheral blood eosinophil counts 6.