From the Guidelines
Asthma control medications should prioritize inhaled corticosteroids (ICS) as the cornerstone of treatment, with long-acting beta-agonists (LABAs) added for moderate to severe persistent asthma, as this combination has been shown to improve asthma control and reduce exacerbations 1.
Long-term Control Medications
- Inhaled corticosteroids (ICS) are the most effective long-term control medication for persistent asthma, reducing airway inflammation and preventing symptoms 1.
- Long-acting beta-agonists (LABAs) such as salmeterol and formoterol are often combined with ICS for better control in moderate to severe persistent asthma 1.
- Leukotriene modifiers like montelukast can help some patients, particularly those with allergic asthma, but are generally considered alternative or add-on therapy 1.
Quick-relief Medications
- Short-acting beta-agonists (SABAs) like albuterol are used as needed for quick relief during symptoms 1.
- Anticholinergics like ipratropium bromide may be used as an alternative bronchodilator for patients who do not tolerate SABAs 1.
Treatment Approach
- Treatment should be stepped up or down based on symptom control, with regular follow-ups to assess effectiveness 1.
- Proper inhaler technique is crucial for medication effectiveness, and patients should rinse their mouth after using steroid inhalers to prevent thrush 1.
- The goal of treatment is to achieve and maintain control of symptoms, with a focus on reducing morbidity, mortality, and improving quality of life 1.
From the FDA Drug Label
The incidence of adverse reactions associated with fluticasone propionate and salmeterol inhalation powder in Table 2 is based upon two 12-week, placebo-controlled, U. S. clinical trials (Trials 1 and 2). A total of 705 adult and adolescent subjects (349 females and 356 males) previously treated with salmeterol or ICS were treated twice daily with fluticasone propionate and salmeterol inhalation powder (100 mcg/50 mcg or 250 mcg/50 mcg doses), fluticasone propionate inhalation powder (100 or 250 mcg doses), salmeterol inhalation powder 50 mcg, or placebo The medication fluticasone propionate and salmeterol inhalation powder is used for asthma control.
- The medication is administered twice daily, with doses of 100 mcg/50 mcg or 250 mcg/50 mcg.
- Common adverse reactions include upper respiratory tract infection, pharyngitis, and hoarseness/dysphonia.
- The medication should be used with caution due to potential risks of serious asthma-related events, cardiovascular and central nervous system effects, and systemic and local corticosteroid use 2.
From the Research
Medications for Asthma Control
Medications play a crucial role in managing asthma symptoms and preventing exacerbations. The following are some key points to consider:
- Inhaled corticosteroids (ICSs) and long-acting beta(2)-adrenoceptor agonists (LABAs) are commonly used in combination to control asthma symptoms 3, 4.
- Studies have shown that combination therapy with ICSs and LABAs is more effective in improving lung function and reducing asthma symptoms than ICSs alone 3, 4.
- The use of "as-needed" ICSs, in which patients receive ICSs whenever they take their reliever inhaler, can improve asthma morbidity outcomes and reduce the risk of severe exacerbations 5.
- Once-daily administration of inhaled corticosteroids can be as effective as twice-daily administration in controlling asthma symptoms, and may improve patient compliance with treatment 6.
- Reducing the dose of ICSs while adding a LABA can maintain control of airway inflammation and clinical asthma control, confirming current guideline recommendations 7.
Key Medications
Some key medications used to control asthma symptoms include:
- Salmeterol/fluticasone propionate (SFC) 3, 4
- Fluticasone propionate (FP) 3, 7
- Formoterol 5
- Albuterol 5
- Budesonide 6
- Beclomethasone dipropionate 6
- Montelukast 4
Treatment Strategies
Treatment strategies for asthma control may involve: