What are the treatment guidelines for asthma?

From the Guidelines

Asthma treatment should follow a stepwise approach, prioritizing inhaled corticosteroids (ICS) as the cornerstone of therapy, with adjustments based on symptom severity and control, as recommended by the National Asthma Education and Prevention Program (NAEPP) guidelines 1.

Key Components of Asthma Management

• Assessment of asthma control, including current impairment and future risks
• Patient education on recognizing good asthma control and the importance of adherence to treatment plans
• Use of short-acting beta-agonists (SABAs) for acute symptom relief
• Inhaled corticosteroids (ICS) as the primary treatment for persistent asthma, with low to medium doses for mild to moderate persistent asthma
• Combination therapy with ICS plus long-acting beta-agonists (LABAs) for moderate to severe persistent asthma
• Consideration of oral corticosteroids, biologics like omalizumab, mepolizumab, or dupilumab for severe asthma

Stepwise Approach for Managing Asthma

• Step up therapy if symptoms are not well-controlled, considering factors such as adherence, environmental control, and comorbid conditions
• Step down therapy if asthma is well-controlled for at least three months, aiming to use the lowest effective dose to minimize side effects
• Regular monitoring and adjustment of therapy based on symptom control, with the goal of achieving and maintaining good asthma control over time, as emphasized by the NAEPP guidelines 1 and supported by studies on asthma management 1.

Importance of Patient Education and Adherence

• Patients should be educated on proper inhaler technique and the importance of adherence to their treatment plans
• Patients should be empowered to recognize good asthma control and to seek medical attention if their symptoms are not well-controlled
• Regular follow-up appointments with healthcare providers are crucial to monitor asthma control and adjust treatment plans as needed, as highlighted in the Mayo Clinic Proceedings article on managing asthma in primary care 1.

From the FDA Drug Label

PRECAUTIONS General Albuterol, as with all sympathomimetic amines, should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias and hypertension, in patients with convulsive disorders, hyperthyroidism or diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines Information for Patients The action of albuterol sulfate inhalation solution may last up to six hours, and therefore it should not be used more frequently than recommended Do not increase the dose or frequency of medication without medical consultation. If symptoms get worse, medical consultation should be sought promptly.

The treatment guidelines for asthma using albuterol include:

• Using the medication with caution in patients with certain medical conditions, such as cardiovascular disorders or diabetes mellitus
• Not using the medication more frequently than recommended, and seeking medical consultation if symptoms worsen
• Not increasing the dose or frequency of medication without medical consultation
• Being aware of potential interactions with other medications, such as monoamine oxidase inhibitors or tricyclic antidepressants 2

From the Research

Treatment Guidelines for Asthma

The treatment guidelines for asthma vary depending on the severity of the disease.

• For patients with mild persistent asthma, treatment options include:
  • Using a combination beclometasone/albuterol inhaler on an as-needed basis 3
  • Daily treatment with an oral leukotriene receptor antagonist together with as-needed use of a short-acting beta2-agonist (SABA) inhaler 3
  • Using a combination inhaled corticosteroid/long-acting beta2-agonist inhaler once-daily together with as-needed SABA 3
• For patients with mild asthma, beta-agonists are considered first-line therapy for intermittent asthmatics, and low-dose inhaled corticosteroids are recommended in addition to reliever medication for persistent asthma 4
• The use of a single combined (fast-onset beta₂-agonist plus an inhaled corticosteroid (ICS)) inhaler only used as needed in people with mild asthma has been shown to be effective in reducing exacerbations and hospital admissions 5
• Inhaled corticosteroid (ICS) therapy in combination with long-acting beta-adrenergic agonists represents the most important treatment for chronic airways diseases such as asthma and chronic obstructive pulmonary disease (COPD) 6

Severe Asthma

• For patients with severe asthma, stepping up from ICS/LABA to more aggressive therapeutic measures would be justified, though several aspects have to be checked in advance (including inhaler technique, adherence to therapy, and possible associated comorbidities) 7
• Possible strategies for severe asthma include the addition of a leukotriene receptor antagonist or tiotropium to the treatment regimen 7
• Oral corticosteroids have commonly been used for the treatment of patients with severe asthma in the past; however, the use of oral corticosteroids is commonly associated with corticosteroid-related adverse events and comorbidities, and patients should be referred to experts who specialize in the treatment of severe asthma to check further therapeutic options including biologics before starting treatment with oral corticosteroids 7

General Principles

• Patient education, which includes a written action plan, should be a component of the patient's strategy for disease management 4
• Compliance to regular therapy can pose problems for disease management, and regular anti-inflammatory therapy may become necessary if symptoms become more persistent 4