From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
The recommended treatment for brittle asthma involves a multifaceted approach, prioritizing high-dose inhaled corticosteroids and long-acting beta-agonists, with consideration of additional therapies to minimize morbidity, mortality, and improve quality of life. Treatment typically begins with high-dose inhaled corticosteroids (such as fluticasone 500-1000mcg twice daily or equivalent) combined with long-acting beta-agonists (like salmeterol 50mcg twice daily or formoterol 12mcg twice daily) 1.
Key Components of Treatment
- High-dose inhaled corticosteroids
- Long-acting beta-agonists
- Additional controller medications:
- Leukotriene modifiers (montelukast 10mg daily)
- Long-acting muscarinic antagonists (tiotropium 18mcg daily)
- Theophylline (dose adjusted based on serum levels)
- Biological therapies for specific inflammatory pathways:
- Omalizumab for allergic asthma (150-375mg subcutaneously every 2-4 weeks)
- Mepolizumab or benralizumab for eosinophilic asthma
- Dupilumab for type 2 inflammation
- Oral corticosteroids (typically prednisone 5-40mg daily) for maintenance in some cases
- Rescue medication (albuterol/salbutamol) and a personalized action plan
Considerations for Effective Treatment
- Identifying and addressing triggers
- Ensuring proper inhaler technique
- Managing comorbidities like GERD or sinusitis
- Considering bronchial thermoplasty in select cases
- Regular specialist follow-up for close monitoring and frequent adjustment of therapy to prevent life-threatening exacerbations 2, 3.
Given the severe and unstable nature of brittle asthma, the most recent and highest quality evidence supports a comprehensive approach that may include combination therapy with salmeterol and fluticasone propionate, as it has been shown to be effective in improving lung function and symptoms, and is well tolerated in patients with asthma 4, 1.