What are the guidelines for managing asthma based on severity of symptoms and lung function?

From the Guidelines

Asthma management should be tailored to symptom severity and lung function measurements, with a stepwise approach for managing asthma in patients 12 years and older, as outlined in the National Heart, Lung, and Blood Institute guidelines 1.

Key Principles of Asthma Management

• For mild intermittent asthma, short-acting beta-agonists like albuterol are sufficient 1.
• For mild persistent asthma, low-dose inhaled corticosteroids (ICS) such as fluticasone are required as controller medication 1.
• For moderate persistent asthma, medium-dose ICS plus a long-acting beta-agonist (LABA) like fluticasone/salmeterol are recommended 1.
• For severe persistent asthma, high-dose ICS-LABA combinations, possibly with add-on therapies like tiotropium, leukotriene modifiers, or biologics such as omalizumab for allergic asthma, are necessary 1.

Importance of Asthma Action Plan

• All patients should have an asthma action plan detailing medication adjustments based on symptom changes, proper inhaler technique instruction, and regular follow-ups to assess control 1.
• The plan should include a written asthma action plan that notes when and how to treat signs of an exacerbation, and instruction on the proper use of inhaled drugs and peak flow meters 1.

Monitoring and Adjusting Treatment

• Regular reassessment of lung function with spirometry helps guide treatment adjustments 1.
• Symptoms and lung function represent different domains of asthma, and they correlate poorly over time in individual patients, so both need to be monitored by clinicians assessing asthma control in clinical practice 1.

Stepwise Approach for Managing Asthma

• The stepwise approach for managing asthma involves stepping up treatment if control is inadequate, and stepping down if asthma is well controlled for at least three months 1.
• This approach is meant to assist, not replace, the clinical decision making required to meet individual patient needs 1.

From the FDA Drug Label

If asthma symptoms arise in the period between doses, an inhaled, short-acting beta2-agonist should be taken for immediate relief. When choosing the starting dosage strength of Wixela Inhub®, consider the patients’ disease severity, based on their previous asthma therapy, including the ICS dosage, as well as the patients’ current control of asthma symptoms and risk of future exacerbation. For patients who do not respond adequately to the starting dosage after 2 weeks of therapy, replacing the current strength of Wixela Inhub with a higher strength may provide additional improvement in asthma control. If a previously effective dosage regimen fails to provide adequate improvement in asthma control, the therapeutic regimen should be reevaluated and additional therapeutic options (e.g., replacing the current strength of Wixela Inhub® with a higher strength, adding additional ICS, initiating oral corticosteroids) should be considered.

The guidelines for managing asthma based on severity of symptoms and lung function involve:

• Using an inhaled, short-acting beta2-agonist for immediate relief of symptoms that arise between doses
• Choosing the starting dosage strength of Wixela Inhub based on the patient's disease severity, previous asthma therapy, and current control of asthma symptoms
• Considering an increase in dosage strength if the patient does not respond adequately to the starting dosage after 2 weeks of therapy
• Reevaluating the therapeutic regimen and considering additional options (e.g., increasing dosage strength, adding ICS, initiating oral corticosteroids) if the patient's symptoms are not adequately controlled 2

From the Research

Asthma Guidelines

Asthma management guidelines are based on the severity of symptoms and lung function. The current concept of asthma therapy is based on a stepwise approach, depending on disease severity, and the aim is to reduce the symptoms that result from airway obstruction and inflammation, to prevent exacerbations and to maintain normal lung function 3.

Stepwise Approach

The stepwise approach to pharmacologic therapy is recommended by the National Heart Lung and Blood Institute guidelines, which provide a framework for managing asthma based on the severity of symptoms and lung function 4. This approach involves:

• Initiating treatment with anti-inflammatory medications, such as inhaled corticosteroids (ICS), for patients with mild persistent asthma
• Adding a long-acting beta2-adrenergic (LABA) bronchodilator to ICS therapy for patients with moderate-to-severe persistent asthma
• Considering the addition of other medications, such as leukotriene receptor antagonists or theophylline, for patients who do not respond to initial therapy

Treatment Options

Treatment options for asthma include:

• Beta2-adrenoceptor agonists and glucocorticoids, which are the most effective drugs for the treatment of airway obstruction and inflammation 3
• Theophylline, leukotriene receptor antagonists, and anticholinergics, which can be used as second- or third-line therapy 3
• Combination treatment with inhaled steroids and LABA, which provides greater asthma control than increasing the ICS dose alone 4
• Leukotriene receptor antagonists, such as montelukast, which can be added to inhaled corticosteroids for patients who continue to experience symptoms despite regular treatment 5

Personalized Approach

A personalized approach to asthma management is recommended, taking into account the individual patient's symptoms, lung function, and response to treatment 6, 7. This approach involves:

• Assessing the patient's symptoms and lung function regularly
• Adjusting treatment based on the patient's response to therapy
• Considering the use of objective measures, such as biomarkers, to guide treatment decisions

Key Considerations

Key considerations in asthma management include:

• Patient adherence to treatment, which can be improved by using combination inhalers and simplifying treatment regimens 3, 4
• The cost of therapy and reimbursement policies, which can influence treatment choices 3
• The need for ongoing monitoring and adjustment of treatment to ensure optimal control of symptoms and prevention of exacerbations 6, 7