From the Guidelines
Current asthma guidelines recommend a stepwise approach to treatment based on symptom severity and control, with inhaled corticosteroids (ICS) as the cornerstone of therapy for persistent asthma, and a focus on achieving and maintaining good asthma control over time, as outlined in the National Asthma Education and Prevention Program (NAEPP) guidelines 1.
Key Recommendations
- For mild intermittent asthma, as-needed short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are the primary treatment.
- For persistent asthma, daily ICS form the cornerstone of therapy, with low doses (such as fluticasone 88-220 mcg daily) for mild persistent asthma, increasing to medium or high doses for more severe cases.
- If symptoms persist despite low-dose ICS, adding a long-acting beta-agonist (LABA) like salmeterol or formoterol is recommended, often in combination inhalers like Advair or Symbicort.
- For severe asthma, additional controllers may include long-acting muscarinic antagonists (tiotropium), leukotriene modifiers (montelukast 10mg daily), or biologics targeting specific inflammatory pathways (omalizumab, mepolizumab, benralizumab) 1.
Asthma Management
- All patients should have an asthma action plan, receive education on proper inhaler technique, and undergo regular assessment of control.
- Environmental trigger avoidance and treating comorbidities like allergic rhinitis or GERD are also essential.
- The stepwise approach allows for treatment intensification when control is inadequate and step-down when good control is maintained, targeting the underlying airway inflammation while providing symptom relief 1.
Ongoing Management
- Ongoing management centers on controller medications, with ICS as the fundamental and first-line therapy.
- Written action plans detailing medications and environmental control strategies tailored for each patient are recommended for all patients with asthma.
- Planned asthma-care visits are essential for adequate teaching and asthma control, with patients on controller agents seen at least twice yearly, and as often as every four months 1.
From the Research
Current Guidelines for Asthma Management
The current guidelines for asthma management recommend the use of inhaled corticosteroids (ICS) as the cornerstone of therapy, with the goal of achieving and maintaining control of asthma symptoms and preventing exacerbations 2, 3, 4, 5, 6.
Inhaled Corticosteroids (ICS) Therapy
- ICS should be introduced early in the treatment of persistent asthma, with the aim of gaining clinical and functional control of the disease 3, 6.
- The starting dose of ICS should be low, with the goal of finding the lowest effective dose through a step-down procedure 3.
- ICS should be used regularly, with daily administration being more effective than intermittent use in achieving and maintaining asthma control 2, 3.
- The combination of ICS and a long-acting beta-agonist (LABA) is recommended for patients with moderate to severe persistent asthma who are not well controlled on ICS alone 2, 5, 6.
As-Needed ICS Strategies
- As-needed ICS strategies, in which patients receive ICS whenever they take their reliever inhaler, can improve asthma morbidity outcomes and reduce the risk of severe exacerbations 4.
- This approach can be particularly beneficial for patients with mild persistent asthma, who may not require daily ICS therapy 4.
Treatment Options for Initial Maintenance Therapy
- ICS are considered the most effective anti-inflammatory medication for the treatment of persistent asthma, regardless of severity 5.
- Leukotriene receptor antagonists (LTRAs) may be used as an alternative to ICS in some patients, but ICS are generally more effective in achieving asthma control 5.
- The combination of ICS and LABA is a effective option for initial maintenance therapy in patients with moderate to severe persistent asthma 5.