From the Guidelines
The gold standard for asthma treatment is a stepwise approach using inhaled corticosteroids (ICS) as the foundation of long-term control therapy. For mild intermittent asthma, short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are used for symptom relief 1. For persistent asthma, low-dose ICS such as fluticasone (88-220 mcg twice daily) or budesonide (180-360 mcg twice daily) are the primary controller medications. As asthma severity increases, treatment escalates to include combination therapy with ICS plus long-acting beta-agonists (LABAs) like fluticasone/salmeterol or budesonide/formoterol 1.
Key Components of Asthma Treatment
- Inhaled corticosteroids (ICS) reduce airway inflammation and are the most consistently effective long-term control medication for persistent asthma 1
- Long-acting beta-agonists (LABAs) are used in combination with ICS for long-term control and prevention of symptoms in moderate or severe persistent asthma 1
- Short-acting beta-agonists (SABAs) are used for rapid reversal of airflow obstruction and prompt relief of asthmatic symptoms 1
- Leukotriene modifiers, such as montelukast, can be used as alternative or adjunctive therapy for mild persistent asthma 1
Treatment Approach
The stepwise approach for asthma treatment involves:
- Initiating treatment with low-dose ICS for mild persistent asthma
- Adding LABAs to ICS for moderate persistent asthma
- Increasing the dose of ICS or adding other controllers, such as leukotriene modifiers or biologics, for severe persistent asthma 1
- Regularly reassessing and adjusting treatment based on symptom control, with the goal of using the lowest effective dose to minimize side effects while maintaining control 1
From the FDA Drug Label
HIGHLIGHTS OF PRESCRIBING INFORMATION ... INDICATIONS AND USAGE 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)
The gold standard for asthma treatment is not explicitly stated in the provided drug label. However, based on the information provided, inhalation corticosteroids and long-acting beta2-adrenergic agonists (LABAs), such as fluticasone propionate and salmeterol, are commonly used for the treatment of asthma.
- The label indicates that Wixela Inhub, a combination of fluticasone propionate and salmeterol, is used for the twice-daily treatment of asthma in patients aged 4 years and older. However, it is essential to note that the label does not provide a clear answer to the question of what the gold standard for asthma treatment is. 2
From the Research
Asthma Treatment
The gold standard for asthma treatment involves a combination of medications, including:
- Inhaled corticosteroids (ICS) as the mainstay of treatment 3, 4, 5
- Long-acting beta-agonists (LABA) for patients with moderate or severe disease 3, 4, 5, 6
- A stepwise approach to therapy, with treatment stepped up or down based on adequacy of asthma control 4, 5
Combination Therapy
Combination therapy of ICS and LABA is established as a most effective treatment for moderate to severe asthma, providing better day-to-day control and a reduction in exacerbations compared with monotherapy with ICS at a lower dose 3. The benefits of combination therapy include:
- Better control of symptoms
- Reduced risk of exacerbations
- Improved lung function
- Reduced need for short-acting beta-agonists
Treatment Strategies
Asthma treatment is based on a stepwise and control-based approach, involving an iterative cycle of assessment, adjustment of treatment, and review of response aimed to minimize symptom burden and risk of exacerbations 7. Treatment strategies include:
- Anti-inflammatory treatment as the mainstay of asthma management
- Use of reliever and controller medications
- Individualized treatment tailored to the severity of the disease and phenotypic characteristics of each patient 4