What is the first-line treatment for asthma patients?

From the Guidelines

The first line treatment for asthma patients is inhaled corticosteroids, as they are the preferred controller medication and have been shown to improve asthma control more effectively than any other single long-term control medication 1. When managing asthma, it's crucial to consider the severity and persistence of symptoms. For patients with mild persistent asthma, inhaled corticosteroids are the foundation of care, and they should be taken daily on a long-term basis to achieve and maintain control of symptoms.

• Key points to consider when prescribing inhaled corticosteroids include:
  • They are the preferred controller medication for persistent asthma
  • They should be taken daily on a long-term basis
  • 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 In addition to inhaled corticosteroids, inhaled short-acting beta agonists are the most effective therapy for rapid reversal of airflow obstruction and prompt relief of asthmatic symptoms 1.
• It's essential to note that:
  • Increasing the use of short-acting beta agonists or using them more than two days per week or more than two nights per month generally indicates inadequate control of asthma
  • Oral systemic corticosteroids should be used to treat moderate to severe asthma exacerbations Proper inhaler technique is crucial for medication effectiveness, and patients should rinse their mouth after using inhaled corticosteroids to prevent oral thrush. Treatment should be reassessed every 3-6 months and adjusted based on symptom control.

From the FDA Drug Label

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 first line treatment for asthma patients is not explicitly stated in the provided drug label. However, it can be inferred that Wixela Inhub, a combination of a corticosteroid and a LABA, is not the first line treatment, as it is indicated for twice-daily treatment of asthma in patients aged 4 years and older, and the label warns against using LABA monotherapy as the primary treatment. The label does mention that the starting dosage is based on asthma severity 2.

Key points:

• Wixela Inhub is indicated for twice-daily treatment of asthma in patients aged 4 years and older.
• Starting dosage is based on asthma severity.
• LABA monotherapy increases the risk of serious asthma-related events.

From the Research

First Line Treatment for Asthma Patients

• Inhaled corticosteroids (ICS) are considered the first line treatment for asthma patients, especially for those with mild persistent asthma 3.
• ICS should be given on a daily basis at a low dose to prevent severe exacerbations and disease deterioration 3.
• For patients with moderate persistent asthma, the combination of an ICS and a long-acting beta-agonist (LABA) is preferred 3.
• The combination of an ICS and LABA in a single inhaler represents a safe, effective, and convenient treatment option for the management of patients with asthma unstable on inhaled steroids alone 3.
• As-needed ICS strategies, in which patients receive ICSs whenever they take their reliever inhaler, can improve asthma morbidity outcomes, particularly by reducing severe exacerbations and reducing the risk of adverse effects of oral corticosteroids 4.

Treatment Options

• Fluticasone/salmeterol and budesonide/formoterol are two common fixed-dose combination options for asthma treatment, with similar efficacy in terms of lung function outcomes, symptoms, and rescue medication use 5.
• Fluticasone furoate/vilanterol (FF/VI) has been shown to reduce the risk of severe asthma exacerbations and improve lung function and symptom control in patients with asthma, with real-world data indicating better asthma control compared to budesonide/formoterol (B/F) 6.
• ICS remain pivotal drugs in asthma management, but research is needed to find complementary drugs for refractory asthma and potentially new classes of drugs as first-line treatment in mild to moderate noneosinophilic asthma 7.