From the Guidelines
The first-line treatment for asthma is typically a short-acting beta-agonist (SABA) inhaler such as albuterol, used as needed for symptom relief, and for patients with persistent asthma symptoms, daily low-dose inhaled corticosteroids (ICS) become the primary controller medication. According to the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma-summary report 2007 1, ICSs are the most consistently effective long-term control medication at all steps of care for persistent asthma. The standard adult dose for albuterol is 1-2 puffs every 4-6 hours as needed, while ICS dosing varies by specific medication but is typically 1-2 puffs twice daily. Proper inhaler technique is crucial for effective medication delivery - patients should exhale fully before inhaling the medication slowly and deeply, then hold their breath for 5-10 seconds.
These medications work by different mechanisms: SABAs provide immediate relief by relaxing airway smooth muscles, while ICS reduce airway inflammation over time, decreasing hypersensitivity and preventing asthma attacks. The medical therapy for asthma updates from the NAEPP guidelines in 2010 1 also support the use of ICS as the preferred controller medication, and combining long-acting beta agonists and ICS is effective and safe when ICS alone are insufficient. Treatment should be regularly reassessed and adjusted based on symptom control, with the goal of using the lowest effective dose to maintain control while minimizing side effects. Key points to consider in asthma management include:
- Using SABAs as needed for symptom relief
- Initiating ICS for persistent asthma symptoms
- Combining LABAs and ICS for moderate to severe persistent asthma
- Regularly reassessing and adjusting treatment based on symptom control
- Minimizing side effects by using the lowest effective dose.
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 asthma treatment is not explicitly stated in the provided drug label. However, it can be inferred that Wixela Inhub is used for the treatment of asthma, but it is a combination product containing a corticosteroid and a LABA, which is typically used for long-term control and prevention of symptoms, rather than as a first-line treatment. Key points:
- Wixela Inhub is indicated for twice-daily treatment of asthma in patients aged 4 years and older.
- The label does not provide information on the first-line treatment for asthma. 2
From the Research
First Line Asthma Treatment
- Inhaled corticosteroids (ICSs) are recognized as the cornerstone of asthma therapy and are considered the most effective anti-inflammatory medication for the treatment of persistent asthma 3.
- ICSs, such as fluticasone propionate and beclomethasone dipropionate, have been shown to be more effective than leukotriene receptor antagonists (LTRAs) as initial maintenance therapy 3, 4.
- The use of ICSs is associated with greater improvements in lung function, asthma control, and quality of life compared to LTRAs 3, 4, 5.
- Combination therapy with ICSs and a long-acting beta2-agonist (LABA) may be a more effective option for the management of persistent asthma than treatment with a single-controller agent alone (ICS or LTRA) 3, 6, 5.
- First-line treatment for asthma is inhaled salbutamol, used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger, or on a daily basis if necessary, in combination with an inhaled corticosteroid such as beclometasone, for patients with persistent asthma 7.
Treatment Options
- Fluticasone propionate is more effective than LTRAs as initial maintenance therapy, producing greater improvements in lung function and asthma control 3.
- Beclomethasone dipropionate is also an effective inhaled steroid for the treatment of asthma, and is often used in combination with a LABA 3, 5, 7.
- Salmeterol and formoterol are LABAs that are commonly used in combination with ICSs for the treatment of asthma 6, 5.
- Leukotriene receptor antagonists, such as montelukast and zafirlukast, may be used as alternative therapy for patients who are unable to tolerate ICSs or LABAs 3, 4.