From the Guidelines
The first-line treatment for Step 1 asthma is a short-acting beta-2 agonist (SABA) such as albuterol (also called salbutamol), used as needed for symptom relief. The typical dose is 2 puffs (90 mcg per puff) via metered-dose inhaler as needed for symptoms, not to exceed 4-6 times daily. Patients should carry their rescue inhaler at all times for quick relief of occasional symptoms like wheezing, coughing, or shortness of breath. Proper inhaler technique is essential: shake the inhaler, exhale fully, place the mouthpiece between lips, inhale slowly while activating the inhaler, hold breath for 10 seconds, then exhale slowly. If symptoms occur more than twice weekly or if nighttime awakenings due to asthma happen more than twice monthly, this indicates inadequate control and the patient should be stepped up to Step 2 treatment. SABAs work by relaxing the smooth muscles around the airways, providing quick bronchodilation within minutes. Overuse of rescue inhalers (more than 2 canisters per year) suggests poor asthma control and should prompt reassessment of the treatment plan, as recommended by the most recent guidelines 1.
Key Points to Consider
- The stepwise approach for managing asthma should be based on asthma control, with the goal of achieving and maintaining control of symptoms and preventing future exacerbations 1.
- Patient education and self-management are crucial components of asthma treatment, including proper inhaler technique, recognition of symptoms, and adherence to treatment plans 1.
- The choice of treatment should be individualized based on the patient's response to treatment, medical history, and other factors, with consideration of the potential risks and benefits of different medications 1.
- Regular assessment and monitoring of asthma control are essential to adjust treatment plans as needed and prevent exacerbations 1.
Recommendations for Practice
- Clinicians should work with patients to develop a personalized treatment plan that takes into account their individual needs and circumstances.
- Patients should be educated on proper inhaler technique, symptom recognition, and self-management strategies to improve asthma control.
- Regular follow-up appointments should be scheduled to monitor asthma control and adjust treatment plans as needed.
From the FDA Drug Label
The provided drug labels do not directly address the first step in asthma treatment.
The FDA drug label does not answer the question.
From the Research
Asthma Treatment
The first step in asthma treatment typically involves the use of medications to control symptoms and prevent exacerbations.
- The recommended treatment for mild asthma is regular maintenance inhaled corticosteroids (ICSs) with a short-acting β-agonist as a separate inhaler used when needed for symptom relief 2.
- However, the Global Initiative for Asthma 2019 strategy for the management of asthma recommends a significant departure from traditional treatments, suggesting that short-acting beta agonists (SABAs) should no longer be used as the preferred reliever for patients when they are symptomatic 3.
- Instead, the use of a combined inhaled corticosteroid-fast acting beta agonist as a reliever is recommended 3.
- Inhaled corticosteroids (ICSs) are recognized as the cornerstone of asthma therapy and are considered to be the most effective anti-inflammatory medication currently available for the treatment of persistent asthma 4.
Treatment Options
Treatment options for initial maintenance therapy of persistent asthma include:
- Inhaled corticosteroids (ICSs) 4
- Leukotriene receptor antagonists (LTRAs) 4
- Combination therapy with ICSs and a long-acting beta2-agonist 4
- Add-on tiotropium for patients with uncontrolled asthma taking ICS plus LABA 5
Key Considerations
Key considerations in asthma treatment include: