What is the recommended treatment approach for managing asthma based on symptom severity and lung function?

From the Guidelines

The recommended treatment approach for managing asthma is a stepwise strategy based on symptom severity and lung function, with the goal of achieving optimal asthma control and reducing the risk of exacerbations, as proposed by the most recent study 1.

Asthma Classification and Management

The stepwise approach to pharmacological treatment in adult asthma mandates that asthma treatment is progressively stepped up to achieve symptom control and reduce the risk of exacerbations and stepped down after a period of prolonged control 1.

• For mild intermittent asthma, as-needed short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are sufficient.
• For mild persistent asthma, low-dose inhaled corticosteroids (ICS) such as fluticasone (100-250 mcg twice daily) or budesonide (180-360 mcg twice daily) are added as controller medication.
• Moderate persistent asthma requires medium-dose ICS plus a long-acting beta-agonist (LABA) like salmeterol or formoterol, often in combination inhalers such as Advair or Symbicort.
• Severe persistent asthma may require high-dose ICS-LABA combinations plus additional controllers like tiotropium (Spiriva, 2.5 mcg daily), leukotriene modifiers (montelukast 10mg daily), or biologics for specific phenotypes.

Treatment Effectiveness and Monitoring

All patients should have a rescue inhaler and an asthma action plan. Treatment effectiveness should be assessed by symptom control, exacerbation frequency, and lung function tests (FEV1) 1.

• The stepwise approach targets underlying airway inflammation while providing bronchodilation, with treatment intensity increased or decreased based on symptom control and lung function measurements over time.
• It is also important to consider that symptom control and the elimination of the risk of asthma attacks are not synonymous, and that biomarkers of type-2 airway inflammation are independently associated with the risk of asthma attacks 1.

Key Considerations

• The disparity between patients’ perceptions and guideline assessment of control may be due to partially controlled asthma being associated with near-maximal levels of quality of life, with minimal impairment 1.
• Comorbidities and lifestyle/environmental factors that contribute to poor control should be specifically managed to lead to better outcomes.
• Further research is needed to determine the optimal levels of asthma control and the potential value of different treatment targets, such as control of type-2 airway inflammation, that can be achieved with currently available treatment, based on efficacy, side effects, and cost 1.

From the FDA Drug Label

If asthma symptoms arise in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief. When choosing the starting dosage strength of Wixela Inhub®, consider the patients’ disease severity, based on their previous asthma therapy, including the ICS dosage, as well as the patients’ current control of asthma symptoms and risk of future exacerbation. For patients who do not respond adequately to the starting dosage after 2 weeks of therapy, replacing the current strength of Wixela Inhub with a higher strength may provide additional improvement in asthma control. If a previously effective dosage regimen fails to provide adequate improvement in asthma control, the therapeutic regimen should be reevaluated and additional therapeutic options (e.g., replacing the current strength of Wixela Inhub® with a higher strength, adding additional ICS, initiating oral corticosteroids) should be considered.

The recommended treatment approach for managing asthma is based on symptom severity and lung function.

• Assessing disease severity: Consider the patient's previous asthma therapy, including ICS dosage, as well as their current control of asthma symptoms and risk of future exacerbation.
• Starting dosage: Choose the starting dosage strength of Wixela Inhub based on the patient's disease severity.
• Adjusting treatment: If the patient does not respond adequately to the starting dosage after 2 weeks, consider replacing the current strength with a higher strength or adding additional ICS.
• Reevaluating treatment: If the patient's symptoms are not adequately controlled, reevaluate the therapeutic regimen and consider additional therapeutic options, such as initiating oral corticosteroids 2.
• Using short-acting beta2-agonists: For immediate relief of asthma symptoms, use an inhaled, short-acting beta2-agonist 2.

From the Research

Asthma Classification and Management

Asthma is a chronic disease characterized by episodic or persistent respiratory symptoms and airflow limitation. The recommended treatment approach for managing asthma is based on a stepwise and control-based approach that involves an iterative cycle of assessment, adjustment of the treatment, and review of the response aimed to minimize symptom burden and risk of exacerbations 3.

Treatment Approach

The treatment approach for asthma is based on symptom severity and lung function. The National Heart Lung and Blood Institute guidelines provide a stepwise approach to pharmacologic therapy, with corticosteroid therapy, principally inhaled corticosteroid (ICS) therapy, considered the most effective anti-inflammatory treatment 4.

Stepwise Approach

The stepwise approach to asthma management involves:

• Assessing symptom control and lung function
• Adjusting treatment based on symptom control and lung function
• Reviewing the response to treatment and making further adjustments as needed 3, 5
• Escalating and de-escalating treatment based on symptom control 6

Medications

Several classes of medications are available for the treatment of asthma, including:

• Inhaled corticosteroids (ICS)
• Long-acting beta2-adrenergic (LABA) bronchodilators
• Combination products, such as fluticasone propionate/salmeterol, which deliver a dose of ICS and a dose of LABA 4, 7
• Leukotriene modifiers and theophylline, which can be added to ICS therapy for additional control 4

Benefits of Combination Therapy

Combination treatment with both ICS and LABA provides greater asthma control than increasing the ICS dose alone, while at the same time reducing the frequency and perhaps the severity of exacerbations 4, 7. The convenience of a combination product may improve patient adherence and reduce the morbidity of asthma 4.