From the Guidelines
A rate controller for asthma is typically an inhaled corticosteroid, which is the preferred controller medication for achieving and maintaining control of symptoms. According to the study by 1, inhaled corticosteroids are the foundation of care for persistent asthma and should be taken daily on a long-term basis. The study highlights that inhaled corticosteroids improve asthma control more effectively than any other single long-term control medication.
Some key points to consider when selecting a rate controller for asthma include:
- Inhaled corticosteroids are the first-line controller therapy for most asthma patients
- Combining long-acting beta agonists and inhaled corticosteroids is effective and safe when inhaled corticosteroids alone are insufficient
- Leukotriene receptor antagonists are an alternative, second-line treatment option for patients with mild persistent asthma
- Inhaled short-acting beta agonists are the most effective therapy for rapid reversal of airflow obstruction and prompt relief of asthmatic symptoms, but increasing their use may indicate inadequate control of asthma
It's essential to note that controller medications work by reducing airway inflammation and preventing symptoms rather than providing immediate relief, and they should be taken regularly even when symptoms are not present, as stated in the study by 1. Patients should be monitored for response and potential side effects, with dose adjustments made accordingly.
From the Research
Definition of a Rate Controller for Asthma
A rate controller, also known as a controller medication, is a type of medication used to control and prevent asthma symptoms over time.
Types of Rate Controllers
- Inhaled corticosteroids (ICS) 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 2.
- Long-acting beta2-agonists (LABAs) can be added to ICS as a combination therapy to improve lung function and symptom control 3.
- Leukotriene receptor antagonists (LTRAs) are also used as initial maintenance therapy in patients whose asthma is uncontrolled by bronchodilators alone, but are less effective than ICS 2.
Role of Rate Controllers in Asthma Management
- Regular daily ICS is recommended as the treatment approach in mild persistent asthma, with better symptom control and robust long-term clinical data compared with as-needed ICS-formoterol 4.
- The addition of LABAs to ICS can improve lung function and symptom-free days, but does not significantly reduce the rate of exacerbations over that achieved with ICS alone 3.
- As-needed ICS strategies can improve asthma morbidity outcomes, particularly by reducing severe exacerbations and reducing the risk of adverse effects of oral corticosteroids 5.