What is the recommended approach for managing asthma?

From the Guidelines

The recommended approach for managing asthma involves a stepwise treatment plan tailored to symptom severity and control, as outlined in the most recent guidelines 1.

Key Components of Asthma Management

• A quick-relief inhaler like albuterol for symptom relief, combined with daily controller medications, such as inhaled corticosteroids (ICS) like fluticasone or budesonide, which form the cornerstone of long-term management by reducing airway inflammation 1.
• For moderate to severe asthma, adding a long-acting beta-agonist (LABA) like salmeterol or formoterol to ICS therapy provides better control 1.
• Patients should have a written asthma action plan detailing medication adjustments based on symptom changes, proper inhaler technique, and when to seek emergency care 1.
• Regular follow-up appointments (typically every 3-6 months) allow for treatment adjustments 1.
• Environmental trigger avoidance, including dust mites, pet dander, pollen, and tobacco smoke, is crucial 1.

Stepwise Approach for Managing Asthma

The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs 1.

• Step up if needed, first checking adherence, environmental control, and comorbid conditions 1.
• Assess control and step down if possible (and asthma is well controlled for at least three months) 1.

Patient Education and Self-Management

Patient education and self-management are critical components of asthma care, including training in proper inhaler technique, recognition of signs of worsening asthma, and use of a written asthma action plan 1.

• Patients should be instructed on how to adjust their medications, remove or withdraw from allergens or irritants, and monitor response to treatment 1.

Conclusion is not allowed, so the response ends here.

From the FDA Drug Label

The best way to prevent asthma attacks is to avoid the triggers that bother you or your child Try to identify the specific things that cause problems for you - things such as certain foods, house dust, or animal dander. A successful prevention plan* will do the following: Keep your activities, including exercise, at normal levels. Keep your lungs functioning normally or at a near-normal level Prevent symptoms such as coughing or breathlessness that can keep you up at night, or occur in the early morning hours, or after exertion. Prevent asthma attacks from happening. Avoid unpleasant or harmful side effects that may result from using asthma medicine.

The recommended approach for managing asthma includes:

• Identifying and avoiding triggers such as certain foods, house dust, or animal dander
• Creating a prevention plan that keeps activities at normal levels, lungs functioning normally, and prevents symptoms and attacks
• Taking preventive medicine such as cromolyn sodium to make airways less sensitive to asthma triggers
• Using bronchodilators to relieve asthma attacks when they occur
• Following a healthy lifestyle including a balanced diet, rest, moderate exercise, and avoiding smoking and irritants 2

From the Research

Asthma Management Guide

• The recommended approach for managing asthma involves a stepwise approach, escalating and de-escalating treatment based on symptom control 3.
• Inhaled corticosteroids (ICSs) are the foundation of asthma treatment, and should be taken daily or as needed to improve symptoms and outcomes, even in patients with mild disease 3.
• For patients who do not achieve optimal control of their asthma with low-dose ICS monotherapy, fixed-dose combinations of ICSs and long-acting β2-agonists (LABAs) are the preferred therapy option 4.
• The combination of ICSs and LABAs is effective in achieving asthma control, as it treats both components of asthma pathophysiology, namely inflammation and smooth muscle dysfunction of the airways 5.
• Leukotriene receptor antagonists (LTRAs) can also be used as add-ons to ICS therapy in patients whose asthma is not controlled by ICSs alone, but the addition of an LABA to ICS therapy provides greater improvements in pulmonary function and overall control of asthma 5.

Treatment Options

• Inhaled short-acting β2-agonists provide rapid relief of acute symptoms 6.
• Maintenance with daily inhaled corticosteroids is the standard of care for persistent asthma 6.
• Combination therapy, including inhaled corticosteroids and long-acting β2-agonists, is effective in patients for whom inhaled corticosteroids alone are insufficient 6.
• Other controller approaches include long-acting muscarinic antagonists and biological agents directed against proteins involved in the pathogenesis of asthma 6.

Patient Management

• Management of persistent asthma requires avoidance of aggravating environmental factors, use of short-acting β2-agonists for rapid relief of symptoms, and daily use of inhaled corticosteroids 6.
• Patients with severe asthma generally benefit from consultation with an asthma specialist for consideration of additional treatment, including injectable biologic agents 6.
• A pragmatic approach that sets therapeutic goals for each individual and associates them with the treatable traits of asthma seems more reasonable than the present stepping approach 7.