From the Guidelines
The first line treatment for asthma is a low-dose inhaled corticosteroid (ICS) for long-term control, along with a short-acting beta-2 agonist (SABA) such as albuterol for symptom relief, as recommended by the most recent guidelines 1.
Key Considerations
- Inhaled corticosteroids are the preferred controller medication for persistent asthma, as they improve asthma control more effectively than any other single long-term control medication 1.
- The combination of a SABA and an ICS addresses both the immediate bronchospasm and the underlying airway inflammation, providing effective symptom relief and long-term control.
- Proper inhaler technique is essential for effective medication delivery, and patients should be instructed on how to use their inhaler correctly.
- Treatment effectiveness should be assessed regularly based on symptom control, frequency of rescue inhaler use, and impact on daily activities.
Medication Options
- Common ICS medications include fluticasone, budesonide, and beclomethasone, usually administered twice daily.
- Albuterol is a commonly prescribed SABA, typically used as 2 puffs (90 mcg per puff) as needed for symptoms, not to exceed 8 puffs per day.
Additional Considerations
- For patients with mild persistent asthma, leukotriene receptor antagonists may be considered as an alternative, second-line treatment option 1.
- In adult and adolescent patients with chronic cough due to asthma, inhaled corticosteroids should be considered as first-line treatment, with the option to step up the dose or add a leukotriene inhibitor if response is incomplete 1.
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 is not explicitly stated in the provided drug label. However, it can be noted that Wixela Inhub is indicated for twice-daily treatment of asthma in patients aged 4 years and older.
- Key points:
- Wixela Inhub is used for treatment of asthma.
- It is a combination of a corticosteroid and a LABA.
- The label does not specify it as a first-line treatment. 2
From the Research
First Line Treatment for Asthma
The first line treatment for asthma typically involves the use of inhaled corticosteroids (ICS) as the cornerstone of therapy, due to their effectiveness in reducing airway inflammation and improving symptoms 3, 4.
- Inhaled corticosteroids are considered the most effective anti-inflammatory medication for the treatment of persistent asthma, regardless of severity 3.
- Leukotriene receptor antagonists (LTRAs) may be used as an alternative for patients who cannot tolerate ICS, but studies have shown that ICS are more effective than LTRAs in improving lung function and reducing symptoms 3, 4.
- Combination therapy with ICS and a long-acting beta2-agonist (LABA) may be considered for patients with moderate to severe asthma, as it has been shown to be more effective than ICS alone in improving symptoms and reducing exacerbations 5, 6.
Comparison of Treatment Options
Studies have compared the effectiveness of different ICS and combination therapies, including:
- Fluticasone propionate versus leukotriene receptor antagonists: fluticasone propionate was found to be more effective in improving lung function and reducing symptoms 3.
- Fluticasone/salmeterol versus budesonide/formoterol: the two combination therapies were found to be similar in terms of efficacy, but fluticasone/salmeterol may have a slightly higher risk of serious adverse events 5.
- Inhaled corticosteroids versus leukotriene antagonists as first-line therapy: inhaled corticosteroids were found to be more effective in improving asthma control and reducing exacerbations 4.
Current Guidelines and Recommendations
Current guidelines and recommendations for the treatment of asthma include:
- The use of inhaled corticosteroids as the first line treatment for persistent asthma 6.
- The consideration of combination therapy with ICS and LABA for patients with moderate to severe asthma 6.
- The use of as-needed low-dose ICS-formoterol for patients with mild asthma 6.
- The referral of patients with severe asthma to a specialist for further evaluation and treatment 6.