What is the management plan for asthma patients with normal Pulmonary Function Tests (PFTs)?

From the Guidelines

Asthma patients with normal Pulmonary Function Tests (PFTs) should still be managed based on symptom severity and frequency, as normal PFTs do not exclude asthma, especially if taken between exacerbations. The management plan for these patients typically involves a short-acting beta-agonist (SABA) like albuterol (2 puffs every 4-6 hours as needed) for mild, intermittent symptoms, as recommended by the expert panel report 3 (EPR-3) guidelines 1. For persistent symptoms, low-dose inhaled corticosteroids (ICS) such as fluticasone (100-250 mcg twice daily) or budesonide (180-360 mcg twice daily) are recommended as controller medications. Some key points to consider in the management of asthma patients with normal PFTs include:

• Patient education on proper inhaler technique, trigger avoidance, and development of a written asthma action plan are essential components of management, as emphasized in the written action plans compared to medical management alone study 1
• Regular follow-up every 3-6 months is important to assess symptom control and adjust therapy as needed
• Monitoring of pulmonary function and symptom severity is crucial, as symptoms and lung function represent different domains of asthma and correlate poorly over time in individual patients, as stated in the American Thoracic Society/European Respiratory Society statement 1
• The choice of medications depends on the degree of severity of asthma, and individualized stepwise changes in treatment are necessary according to change in severity, as discussed in the inhaled corticosteroids study 1. Overall, the goal of management is to control symptoms, prevent exacerbations, and improve quality of life, while also monitoring for changes in symptom patterns and adjusting therapy as needed.

From the FDA Drug Label

Patients should be advised to take SINGULAIR daily as prescribed, even when they are asymptomatic, as well as during periods of worsening asthma, and to contact their physicians if their asthma is not well controlled.

The management plan for asthma patients with normal Pulmonary Function Tests (PFTs) is to continue taking SINGULAIR daily as prescribed, even when asymptomatic, and to contact their physicians if their asthma is not well controlled 2.

• Patients should have appropriate short-acting inhaled β-agonist medication available to treat asthma exacerbations.
• Patients who have exacerbations of asthma after exercise should have available for rescue a short-acting inhaled β-agonist.
• The dose of inhaled corticosteroid may be reduced gradually under medical supervision, but SINGULAIR should not be abruptly substituted for inhaled or oral corticosteroids 2.

From the Research

Management Plan for Asthma Patients with Normal PFTs

• Asthma patients with normal Pulmonary Function Tests (PFTs) may still experience symptoms, representing a management challenge 3
• The management plan for these patients may involve adding a leukotriene receptor antagonist (LTRA) or a long-acting beta2-agonist (LABA) to their treatment regimen, in addition to inhaled corticosteroids 3
• Paradoxical bronchoconstriction is a potential adverse event that can occur with the administration of short-acting beta agonists (SABAs), which can be used to manage asthma symptoms 4
• Control charts have been shown to have limited utility in monitoring lung function in asthma patients, and may not be suitable for use in many patients 5
• Diagnosing asthma and determining the degree of severity of the disease involves establishing a history of variable chest symptoms and measuring peak expiratory flow (PEF) 6
• Pulmonary function testing can have an impact on the management of acute asthma, with knowledge of test results changing management in a significant number of patients 7

Key Considerations

• Asthma patients with normal PFTs may still require treatment to manage symptoms and prevent exacerbations
• The use of SABAs and other medications should be carefully considered, due to the potential for paradoxical bronchoconstriction and other adverse events
• A comprehensive management plan should involve a combination of medication, lifestyle modifications, and regular monitoring to ensure optimal control of asthma symptoms 3, 4, 6