What are the guidelines for the management of asthma (bronchial asthma)?

From the Guidelines

Asthma management involves a stepwise approach tailored to symptom severity and control, with the goal of minimizing morbidity, mortality, and improving quality of life. For mild intermittent asthma, short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are the primary treatment, as recommended by the National Heart, Lung, and Blood Institute 1.

Key Components of Asthma Management

• Inhaled corticosteroids (ICS) form the cornerstone of therapy for persistent asthma, with low-dose options including fluticasone (88-220 mcg twice daily) or budesonide (180-360 mcg twice daily) 1
• As severity increases, treatment escalates to include long-acting beta-agonists (LABAs) like salmeterol or formoterol, often combined with ICS in single inhalers such as Advair (fluticasone/salmeterol) or Symbicort (budesonide/formoterol) 1
• For severe asthma, additional controllers may include leukotriene modifiers (montelukast 10mg daily), long-acting muscarinic antagonists (tiotropium 2.5 mcg daily), or biologics targeting specific inflammatory pathways 1

Supportive Measures

• All patients should have an asthma action plan detailing daily controller medications, rescue medications for exacerbations, and when to seek emergency care, as outlined in the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1
• Regular follow-up every 1-6 months depending on control is essential to adjust therapy, with a focus on assessing asthma control and adjusting treatment accordingly 1
• Environmental trigger avoidance, proper inhaler technique education, and annual influenza vaccination are crucial supportive measures to reduce morbidity and mortality in asthma patients 1

Home Management

• Patients should be instructed on how to use a written asthma action plan, recognize early indicators of an exacerbation, and adjust their medications as needed, including increasing SABA and adding a short course of oral systemic corticosteroids if necessary 1
• Home management techniques that are not recommended due to lack of effectiveness include drinking large volumes of liquids, breathing warm, moist air, or using over-the-counter products such as antihistamines or cold remedies 1

From the FDA Drug Label

Wixela Inhub® is a combination product containing a corticosteroid and a long-acting beta2-adrenergic agonist (LABA) indicated for: • Twice-daily treatment of asthma in patients aged 4 years and older. (1.1)

For oral inhalation only. (2) • Treatment of asthma in patients aged 12 years and older: 1 inhalation of Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily. Starting dosage is based on asthma severity. (2. 1) • Treatment of asthma in patients aged 4 to 11 years: 1 inhalation of Wixela Inhub® 100/50 twice daily. (2.1)

The management of asthma with Wixela Inhub® involves twice-daily treatment with the inhalation powder, with the dosage based on asthma severity. The recommended dosages are:

• For patients aged 12 years and older: 1 inhalation of Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily.
• For patients aged 4 to 11 years: 1 inhalation of Wixela Inhub® 100/50 twice daily 2.

From the Research

Management of Asthma

• The management of asthma involves the use of various medications, including inhaled corticosteroids (ICSs), long-acting beta-agonists (LABAs), and leukotriene receptor antagonists (LTRAs) 3, 4, 5, 6, 7.
• Studies have shown that the combination of ICSs and LABAs is more effective than the use of either medication alone in achieving asthma control 4, 5, 7.
• The combination of montelukast and salmeterol was found to be inferior to the combination of beclomethasone and salmeterol in protecting against asthma treatment failures, lung function, asthma control score, and markers of inflammation and airway reactivity 3.
• Fluticasone propionate was found to be more effective than LTRAs in clinical outcomes, including lung function, asthma control, and quality of life 5.
• The addition of montelukast or salmeterol to fluticasone was found to protect most patients from experiencing an asthma attack during a 1-year period, but the study was inconclusive with regard to a difference between treatment groups 6.
• A retrospective matched cohort study found that initiation of once-daily fluticasone furoate/vilanterol was associated with lower use of short-acting beta-agonists and fewer asthma-related exacerbations compared with twice-daily budesonide/formoterol 7.

Treatment Options

• Inhaled corticosteroids (ICSs) are recognized as the cornerstone of asthma therapy and are considered to be the most effective anti-inflammatory medication currently available for the treatment of persistent asthma 5.
• Long-acting beta-agonists (LABAs) are recommended for use in combination with ICSs for the treatment of asthma 4, 5, 7.
• Leukotriene receptor antagonists (LTRAs) may be used as add-on therapy for patients whose asthma is not well-controlled with ICSs and LABAs alone 3, 6.

Asthma Control

• Asthma control can be measured by the mean number of short-acting beta-agonist canisters dispensed per patient-year, time to first and rates of overall and severe asthma exacerbations, and lung function 4, 5, 7.
• Studies have shown that the combination of ICSs and LABAs can improve asthma control and reduce the risk of severe asthma exacerbations 4, 5, 7.