What is the recommended treatment for asthma management?

From the Guidelines

The recommended treatment for asthma management involves a stepwise approach tailored to symptom severity, with inhaled corticosteroids (ICS) as the cornerstone of treatment for persistent asthma, as supported by the most recent guidelines 1.

Key Components of Asthma Management

• For mild intermittent asthma, short-acting beta-agonists (SABAs) like albuterol are sufficient.
• For persistent asthma, ICS such as fluticasone (100-500 mcg twice daily) or budesonide (200-800 mcg twice daily) are the preferred treatment.
• As severity increases, combination therapy with long-acting beta-agonists (LABAs) such as salmeterol or formoterol is added to ICS.
• For moderate to severe asthma, additional options include leukotriene modifiers (montelukast 10mg daily), long-acting muscarinic antagonists (tiotropium 2.5 mcg daily), or biologics for specific phenotypes.

Importance of Patient Education and Monitoring

• Patients should have a rescue inhaler available and an asthma action plan detailing medication adjustments during exacerbations.
• Regular follow-up every 1-6 months is essential to assess control and adjust therapy, as emphasized in guidelines from the National Asthma Education and Prevention Program 1.
• Patient education on proper inhaler technique, recognition of worsening symptoms, and the importance of adherence to treatment is crucial, as highlighted in earlier studies 1.

Stepwise Approach for Managing Asthma

• The stepwise approach is meant to assist, not replace, clinical decision-making required to meet individual patient needs, with a preference for treating more aggressively to obtain rapid control, then stepping down to a maintenance regimen 1.
• The severity class is based on the most severe category in which any of the components occur, and patients should be reevaluated two to six weeks after the introduction of medication.

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)

The effect of fluticasone propionate and salmeterol inhalation powder 100 mcg/50 mcg on morning and evening PEF endpoints is shown in Table 5.

The recommended treatment for asthma management is the use of a combination product containing a corticosteroid and a long-acting beta2-adrenergic agonist (LABA), such as Wixela Inhub®, administered as a twice-daily inhalation. The starting dosage is based on asthma severity, with options including Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily for patients aged 12 years and older 2.

From the Research

Asthma Management

Asthma is a chronic inflammatory disease of the airways, and its management involves a stepwise approach to pharmacologic therapy. The National Heart Lung and Blood Institute guidelines recommend the following:

• Corticosteroid therapy, principally inhaled corticosteroid (ICS) therapy, as the most effective anti-inflammatory treatment 3
• Addition of a second long-term control medication to ICS therapy for moderate-to-severe persistent asthma 3

Recommended Treatment

The recommended treatment for asthma management includes:

• Combination treatment with both ICS and long-acting beta2-adrenergic (LABA) bronchodilator, such as fluticasone propionate and salmeterol, for greater asthma control and reduced frequency of exacerbations 3, 4
• Use of a combination-product inhaler, such as Advair, to deliver a dose of ICS and LABA for both inflammatory and bronchoconstrictive components of asthma 3
• Starting ICS treatment at a standard daily dose of 200-250 μg of fluticasone propionate or equivalent, representing the dose at which approximately 80-90% of the maximum achievable therapeutic benefit of ICS is obtained in adult asthma 5

Treatment Strategies

Treatment strategies for stepping down treatment once control has been achieved with fluticasone propionate/salmeterol include:

• Reducing the dose of fluticasone propionate/salmeterol to 100/50 μg twice daily, which is more effective than switching to an inhaled corticosteroid alone 6
• Adding montelukast or salmeterol to fluticasone for protection against asthma attacks, with both treatments showing similar protection against asthma attacks during a 1-year period 7