From the Guidelines
Refractory bronchospasm in asthma is typically treated with high-dose inhaled corticosteroids (CS) combined with a long-acting bronchodilator and/or other long-term controllers.
Treatment Options
- High-dose inhaled CS, such as budesonide, fluticasone propionate, or mometasone, to minimize the number of actuations administered by the patient and potentially improve outcomes 1
- Long-acting bronchodilator, such as salmeterol, or oral theophylline 1
- Leukotriene modifiers, which may be beneficial in some patients, although more studies are needed to define their benefits and risks 1
Assessment and Monitoring
- Assessment of medication adherence is crucial, using methods such as direct questioning, pharmacy records, or devices that monitor medication administration 1
- Development of an action plan and frequent visits to review asthma control are key elements in reducing oral and inhaled CS requirements 1
- Markers of inflammation, such as plasma or sputum eosinophils/eosinophil cationic protein and exhaled nitric oxide, may be helpful in examining medication response in some patients 1
Special Considerations
- Patients with refractory asthma often pose considerable challenges to the successful reduction in systemic CS, and repeated attempts should be made to reduce systemic CS and maintain control with high-dose inhaled CS therapy 1
- Alternative anti-inflammatory and immunomodulating drugs, such as methotrexate, gold, cyclosporine, intravenous gamma globulin, and macrolide antibiotics, have shown modest efficacy in some studies, but their use is not well established and more studies are needed to define their benefits and risks 1
From the Research
Treatment Options for Refractory Bronchospasm in Asthma
- Bronchial thermoplasty is a treatment option for severe refractory asthma that is not well controlled by high-dose inhaled corticosteroids and long-acting bronchodilator therapy 2
- Sevoflurane therapy can be beneficial in treating life-threatening acute severe asthma, as it meets the criteria for both bronchodilator treatment and mechanical ventilation under adequate sedation 3
- Physiotherapy treatment can provide a wide range of treatment options for bronchial asthma, including respiratory reeducation, manual therapy techniques, therapeutic exercise, and relaxation techniques, all of which have shown positive results 4
- Bronchoscopy can help identify phenotypes of refractory asthma and direct therapy, with specific directed therapy yielding significant improvement in asthma control and pulmonary function 5
- Novel therapies targeting key biological targets, such as monoclonal antibodies targeting eosinophilic disease, anti-neutrophil strategies, and novel bronchodilators, are becoming available for the treatment of severe asthma 6
Emerging Therapies
- Monoclonal antibodies targeting eosinophilic disease may be effective in treating severe asthma 6
- Anti-neutrophil strategies may be beneficial in treating severe asthma 6
- Novel bronchodilators are being developed for the treatment of severe asthma 6