From the Guidelines
For severe asthma uncontrolled on Symbicort 160, the most effective alternative treatment is to add a long-acting muscarinic antagonist (LAMA) like tiotropium (Spiriva) 18mcg daily via inhaler, as it works through a different mechanism to improve bronchodilation 1.
Treatment Options
Several treatment options exist for severe asthma uncontrolled on Symbicort 160, including:
- Adding a LAMA like tiotropium (Spiriva) 18mcg daily via inhaler, which is often the first step, as it works through a different mechanism to improve bronchodilation 1
- Biologics targeting specific inflammatory pathways, such as:
- Anti-IgE therapy (omalizumab) for allergic asthma, given as subcutaneous injections every 2-4 weeks based on weight and IgE levels
- Anti-IL5 therapies (mepolizumab, benralizumab, or reslizumab) for eosinophilic asthma
- Dupilumab for type 2 inflammation
- Oral corticosteroids like prednisone may be used short-term for exacerbations, but long-term use should be avoided due to side effects 1
- Bronchial thermoplasty, a procedure that reduces airway smooth muscle, might be considered in select cases
Key Considerations
Before changing treatment, it's essential to:
- Verify proper inhaler technique
- Adherence to current medication
- Address any triggers or comorbidities like GERD or sinusitis that could be worsening asthma control These advanced therapies target different aspects of the inflammatory cascade in asthma, providing options when the standard combination of inhaled corticosteroid and long-acting beta-agonist (like Symbicort) proves insufficient 1.
From the Research
Alternative Treatments for Severe Asthma
- For patients with severe asthma uncontrolled on Symbicort (budesonide/formoterol) 160, alternative treatments may include biological therapies, such as mepolizumab, which has been shown to have an oral corticosteroid-sparing effect 2.
- Other options may include single-inhaler combination therapy for maintenance and relief of asthma, such as Symbicort SMART, which has been endorsed as an effective treatment by the Global Initiative for Asthma 3.
- Patients with severe eosinophilic asthma may benefit from treatment with anti-interleukin-5 monoclonal antibodies, such as mepolizumab, which has been shown to improve exacerbation rates, asthma control, and quality of life 2.
Considerations for Treatment
- The choice of alternative treatment should be based on the individual patient's needs and circumstances, including the severity of their asthma, their response to previous treatments, and their preferences and values 4.
- Patients with severe asthma should be closely monitored and their treatment adjusted as needed to achieve optimal control of their symptoms and prevent exacerbations 5.
- The use of oral corticosteroids should be minimized due to their potential for serious adverse effects, and alternative treatments that can reduce or eliminate the need for oral corticosteroids should be considered 2.
Evidence for Alternative Treatments
- Studies have shown that single-inhaler combination therapy, such as Symbicort SMART, can improve asthma outcomes and reduce the risk of severe exacerbations compared to other treatments 3.
- Biological therapies, such as mepolizumab, have been shown to be effective in reducing exacerbations and improving asthma control in patients with severe eosinophilic asthma 2.
- As-needed budesonide-formoterol has been shown to be effective in reducing severe exacerbation rates in patients with mild asthma 6.