From the Guidelines
Asthma treatment should prioritize inhaled corticosteroids as the most potent and consistently effective long-term control medication, with the addition of long-acting beta-agonists for moderate to severe cases, as recommended by the most recent guidelines 1.
Key Recommendations
- Inhaled corticosteroids are the cornerstone of long-term control for persistent asthma, with options like fluticasone (100-500 mcg twice daily) or budesonide (180-720 mcg twice daily) 1.
- For moderate to severe asthma, a combination of inhaled corticosteroids with a long-acting beta-agonist, such as fluticasone/salmeterol (Advair) or budesonide/formoterol (Symbicort), is often prescribed 1.
- Additional options include leukotriene modifiers like montelukast (10mg daily for adults) and biologics for severe asthma, with oral corticosteroids reserved for acute exacerbations 1.
Considerations for Optimal Control
- Achieving well-controlled asthma is possible in approximately 70% of patients across the strata of severity, with a progressive increase in inhaled corticosteroid/long-acting beta-agonist therapy to a maintenance dose that causes the same magnitude of systemic side effects as oral prednisone at a 5-mg daily dose 1.
- Comorbidities and lifestyle/environmental factors that contribute to poor control should be specifically managed to lead to better outcomes 1.
- The goal of treatment should extend beyond symptom control to include the control of type-2 airway inflammation, considering efficacy, side effects, and cost 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)
For oral inhalation only. (2) • Treatment of asthma in patients aged 12 years and older: 1 inhalation of Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily. Starting dosage is based on asthma severity. (2. 1) • Treatment of asthma in patients aged 4 to 11 years: 1 inhalation of Wixela Inhub® 100/50 twice daily. (2.1)
Asthma Treatment: Wixela Inhub® is indicated for twice-daily treatment of asthma in patients aged 4 years and older. The dosage varies based on age and asthma severity.
- For patients aged 12 years and older, the recommended dosage is 1 inhalation of Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50 twice daily.
- For patients aged 4 to 11 years, the recommended dosage is 1 inhalation of Wixela Inhub® 100/50 twice daily 2.
From the Research
Asthma Treatment Overview
- Asthma treatment aims to prevent severe asthma exacerbations and improve symptoms, with inhaled corticosteroids (ICSs) being a key component of management 3.
- ICSs can be used as a daily maintenance therapy or as-needed, with the latter approach empowering patients to adjust their treatment in response to symptom fluctuation 3.
Stepwise Approach to Asthma Management
- A stepwise approach to asthma management is recommended, with treatment escalated or de-escalated based on symptom control 4, 5.
- This approach can be applied in different contexts, including persistent lack of control, temporary loss of control, and day-to-day variability in symptoms 4.
Addition of Alternative Therapies
- For patients whose asthma is uncontrolled with low-dose ICSs, addition of alternative therapies such as montelukast or salmeterol may be considered instead of increasing the steroid dose 6.
- These alternative therapies can provide similar protection against asthma attacks, although differences between treatments may be small 6.
Evidence-Based Guidelines
- Inhaled corticosteroids are the most effective class of controller medication for treating persistent asthma and are recommended as first-line treatment by evidence-based guidelines 7, 5.
- The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all asthma patients be treated with ICSs taken daily or as needed, with a stepwise approach to management 5.