What is the recommended treatment approach for asthma management?

From the Guidelines

The recommended treatment approach for asthma management is a stepwise approach based on symptom severity and control, with the goal of achieving symptom control while minimizing medication side effects and preventing exacerbations. For mild intermittent asthma, short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are the primary treatment 1. For persistent asthma, inhaled corticosteroids (ICS) form the cornerstone of therapy, 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.

Some key points to consider in asthma management include:

• Assessing asthma control and adjusting treatment accordingly 1
• Using a stepwise approach to adjust treatment, with the goal of achieving symptom control while minimizing medication side effects and preventing exacerbations 1
• Considering the use of additional controllers like leukotriene modifiers, long-acting muscarinic antagonists, or biologics for more severe cases 1
• Providing patients with a written asthma action plan, proper inhaler technique training, and regular follow-ups to assess control 1

It's also important to note that the stepwise approach is meant to assist, not replace, clinical decision-making, and that individual patient needs should be taken into account when developing a treatment plan 1. The most recent and highest quality study, published in 2020, supports the use of a stepwise approach to asthma management, with a focus on achieving symptom control and minimizing medication side effects 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 recommended treatment approach for asthma management is twice-daily treatment with Wixela Inhub, a combination of a corticosteroid and a long-acting beta2-adrenergic agonist (LABA), in patients aged 4 years and older. The starting dosage is based on asthma severity. For patients aged 12 years and older, the dosage options are 100/50,250/50, or 500/50 twice daily, while for patients aged 4 to 11 years, the recommended dosage is 100/50 twice daily 2. Key considerations include:

• Asthma severity to determine the starting dosage
• Age of the patient to determine the appropriate dosage
• Contraindications, such as primary treatment of status asthmaticus or acute episodes of asthma, and severe hypersensitivity to milk proteins or demonstrated hypersensitivity to fluticasone propionate, salmeterol, or any of the excipients.

From the Research

Asthma Management

Asthma management involves a combination of medications and lifestyle changes to control symptoms and prevent exacerbations. The recommended treatment approach for asthma management includes:

• Inhaled corticosteroids (ICS) as the primary treatment for long-term control of asthma symptoms 3, 4, 5
• Long-acting beta-agonists (LABAs) in combination with ICS for patients with uncontrolled asthma symptoms 3, 6
• Short-acting beta-agonists (SABAs) for quick relief of acute asthma symptoms 5

Treatment Options

The following treatment options are available for asthma management:

• ICS monotherapy: fluticasone propionate or budesonide 3, 6
• LABA monotherapy: salmeterol or formoterol 6
• Combination therapy: ICS/LABA (e.g., fluticasone/salmeterol or budesonide/formoterol) 3, 6, 7
• Add-on treatments: other medications that can be added to ICS/LABA combination therapy to improve asthma control 5

Stepwise Approach

A stepwise approach to asthma treatment is recommended, with the following steps:

• Step 1: Assess asthma severity and initiate treatment with ICS 5
• Step 2: Add LABA to ICS for patients with uncontrolled symptoms 5
• Step 3: Increase ICS dose or add other medications to improve control 5
• Step 4: Consider add-on treatments or biologic agents for severe asthma 5

Pharmacoeconomic Considerations

Pharmacoeconomic analyses have shown that combination therapy with ICS/LABA (e.g., salmeterol/fluticasone propionate) is a cost-effective treatment option for patients with asthma not controlled with ICS alone 7.