What are the management strategies for respiratory infections in adults with asthma (Asthma)

From the Guidelines

Adults with asthma who develop respiratory infections should seek prompt medical attention and continue using their regular asthma medications, including maintenance inhalers and rescue inhalers as needed, to prevent exacerbations and minimize morbidity, mortality, and impact on quality of life. The management of asthma in adults with respiratory infections involves a combination of pharmacological and non-pharmacological interventions. According to the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1, patient skills such as taking medications correctly, using devices as prescribed, and self-monitoring are crucial in managing asthma.

Key aspects of management include:

• Continuing regular asthma medications, including maintenance inhalers like fluticasone/salmeterol (Advair) or budesonide/formoterol (Symbicort), and increasing the rescue inhaler (albuterol) as needed for symptom relief
• Identifying and avoiding environmental exposures that worsen asthma, such as allergens, irritants, or pollutants
• Monitoring peak flow readings closely during illness and following a written asthma action plan
• Seeking emergency care if severe symptoms occur, such as shortness of breath, inability to speak in full sentences, or minimal relief from the rescue inhaler

Prevention strategies are also essential and include annual flu vaccination, pneumococcal vaccination as recommended, good hand hygiene, and avoiding close contact with sick individuals. The guidelines on the management of asthma by the British Thoracic Society 1 emphasize the importance of patient education, self-management, and recognition of signs of worsening asthma. By prioritizing these interventions, adults with asthma can reduce the risk of respiratory infections triggering exacerbations and improve their overall quality of life. Additionally, education and training on the proper use of inhaled drugs and peak flow meters, as well as knowledge of the difference between bronchodilators and anti-inflammatory treatment, are vital for effective self-management 1.

From the FDA Drug Label

The use of albuterol sulfate inhalation solution can be continued as medically indicated to control recurring bouts of bronchospasm The answer to the question of respiratory infection in adults with asthma is not directly addressed in the provided drug label. Key points:

• The label discusses dosage and administration for adults and children with asthma.
• It mentions the use of albuterol sulfate inhalation solution to control recurring bouts of bronchospasm.
• There is no direct information about respiratory infection in adults with asthma. 2

From the Research

Respiratory Infection in Adults with Asthma

• Asthma is a heterogeneous clinical syndrome primarily affecting the lower respiratory tract, characterized by episodic or persistent symptoms of wheezing, dyspnea, and cough 3
• The diagnosis of asthma requires these symptoms and demonstration of reversible airway obstruction using spirometry, and identifying clinically important allergen sensitivities is useful 3

Treatment of Asthma

• Inhaled short-acting β2-agonists provide rapid relief of acute symptoms, but maintenance with daily inhaled corticosteroids is the standard of care for persistent asthma 3
• Combination therapy, including inhaled corticosteroids and long-acting β2-agonists, is effective in patients for whom inhaled corticosteroids alone are insufficient 3, 4
• Other controller approaches include long-acting muscarinic antagonists and biological agents directed against proteins involved in the pathogenesis of asthma 3

Inhaled Corticosteroid Therapy

• The Global Initiative for Asthma guidelines use the traditional terminology of "low," "medium," and "high" doses of inhaled corticosteroids to define daily maintenance doses 5
• A reclassification of ICS doses based on a "standard daily dose" is proposed, which is defined as 200-250 μg of fluticasone propionate or equivalent 5
• ICS treatment should be started at these standard doses, which then represent the doses at which maintenance ICS are prescribed at step 2 and within ICS/long-acting β-agonist combination therapy at step 3 5

Symptom Control in Patients with Asthma

• Treatment with fluticasone furoate/vilanterol reduces the risk of severe asthma exacerbations and improves lung function and symptom control in patients with asthma 6
• Initiation of maintenance therapy with salmeterol and fluticasone propionate in patients with asthma provides greater improvements in pulmonary function and symptom control than initiation of maintenance therapy with fluticasone propionate alone 4
• First-line treatment for asthma is inhaled salbutamol, used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger 7