What are the treatments for asthma?

From the Guidelines

Asthma treatment should prioritize inhaled corticosteroids as the cornerstone of therapy, with the addition of long-acting beta agonists for moderate to severe cases, as this approach has been shown to effectively reduce airway inflammation and improve symptoms. The treatment of asthma typically involves a combination of medications to manage symptoms and prevent attacks. According to the most recent and highest quality study 1, the stepwise approach to pharmacological treatment in adult asthma mandates that asthma treatment is progressively stepped up to achieve symptom control and reduce the risk of exacerbations.

Long-term Control Medications

The following medications are used for long-term control of asthma:

• Inhaled corticosteroids, such as fluticasone, budesonide, or beclomethasone, which reduce airway inflammation and are used daily for long-term control 1
• Long-acting beta agonists, such as salmeterol or formoterol, which are used in combination with inhaled corticosteroids for long-term control and prevention of symptoms in moderate or severe persistent asthma 1
• Leukotriene modifiers, such as montelukast, which can be used as alternative therapy for mild persistent asthma or as adjunctive therapy with inhaled corticosteroids 1
• Immunomodulators, such as omalizumab, which can be used as adjunctive therapy for patients with severe persistent asthma who have sensitivity to relevant allergens 1

Quick-relief Medications

The following medications are used for quick relief of acute symptoms and exacerbations:

• Short-acting beta agonists, such as albuterol or levalbuterol, which are the treatment of choice for relief of acute symptoms and prevention of exercise-induced bronchospasm 1
• Anticholinergics, such as ipratropium bromide, which can be used as an alternative bronchodilator for patients who do not tolerate short-acting beta agonists 1
• Systemic corticosteroids, which can be used for moderate and severe exacerbations to speed recovery and prevent recurrence of exacerbations 1

Treatment Approach

The treatment approach should be individualized based on the severity of asthma and the patient's response to therapy. The most effective treatment approach is to use a combination of medications that target different aspects of the inflammatory and bronchoconstrictive processes that cause asthma symptoms. Proper inhaler technique is crucial for medication effectiveness, and patients should use a spacer device when appropriate. A written asthma action plan detailing medication schedules and steps to take during worsening symptoms is essential.

From the FDA Drug Label

SINGULAIR is prescribed for the treatment of asthma, the prevention of exercise-induced asthma, and allergic rhinitis: Asthma. SINGULAIR should be used for the long-term management of asthma in adults and children ages 12 months and older. 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.

The treatments for asthma include:

• Long-term management: Montelukast (SINGULAIR) for adults and children ages 12 months and older 2
• Twice-daily treatment: Fluticasone propionate and salmeterol (WIXELA INHUB) for patients aged 4 years and older 3
• Prevention of exercise-induced asthma: Montelukast (SINGULAIR) for patients 15 years of age and older 2 Note that these treatments should be used under the guidance of a doctor and as prescribed.

From the Research

Asthma Treatment Options

• Inhaled corticosteroids (ICS) are considered the cornerstone of asthma therapy and are recommended as first-line therapy for all stages of persistent asthma 4, 5
• Leukotriene receptor antagonists (LTRAs) can be used as initial maintenance therapy in patients whose asthma is uncontrolled by bronchodilators alone, but are less effective than ICS 5
• Combination therapy with ICS and a long-acting beta2-agonist is recommended for patients with severe asthma or those whose asthma is not controlled with ICS alone 5, 6, 7
• Beta-agonists are considered first-line therapy for intermittent asthmatics, while low-dose ICS are recommended for persistent asthma 8
• Antileukotrienes can be considered an option for mild asthma, but are not as effective as ICS 8

Stepping Down Asthma Treatment

• Swedish asthma guidelines recommend treating asthma with the lowest effective dose possible and stepping down treatment when possible 6
• Stepping down asthma treatment can be done safely in certain patient groups while maintaining asthma control, but requires careful consideration of potential risks 6
• An asthma treatment algorithm can be used to guide stepping down treatment, taking into account factors such as asthma control and medication use 6

Medication Options

• Fluticasone propionate and budesonide are two common ICS options, with fluticasone associated with greater improvement in lung function and better asthma symptom control 5, 7
• Formoterol fumarate and salmeterol xinafoate are two common LABA options, with formoterol associated with greater improvement in lung function and better asthma symptom control 7
• Single inhaler combination regimens, such as budesonide/formoterol and fluticasone/salmeterol, can be more effective than monotherapy alone 7