From the Guidelines
Asthma management should prioritize a combination of quick-relief and long-term control medications, with a focus on identifying and treating specific traits that contribute to respiratory symptoms, as suggested by the most recent study in 2020 1. Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms like wheezing, coughing, chest tightness, and shortness of breath.
Key Components of Asthma Management
- Quick relief during asthma attacks using short-acting beta-agonists like albuterol (2 puffs every 4-6 hours as needed)
- Long-term control using inhaled corticosteroids such as fluticasone (Flovent, 88-440 mcg twice daily) or budesonide (Pulmicort, 180-360 mcg twice daily) to reduce inflammation
- Combination therapy with long-acting beta-agonists like salmeterol plus fluticasone (Advair, taken twice daily) or formoterol plus budesonide (Symbicort, taken twice daily) for some patients
- Leukotriene modifiers like montelukast (Singulair, 10mg once daily for adults) as an alternative option
Importance of Personalized Approach
The 2020 study 1 emphasizes the need to develop practical methods to identify treatable traits that contribute to respiratory symptoms in patients with asthma, and to titrate maintenance ICS doses accordingly.
Additional Considerations
- Proper inhaler technique is crucial for medication effectiveness
- Patients should identify and avoid personal asthma triggers, maintain an updated asthma action plan, and have regular follow-ups with healthcare providers
- The goal of asthma management is to control symptoms, prevent exacerbations, maintain normal activity levels, and preserve lung function while minimizing medication side effects, as highlighted in earlier studies 1
From the Research
Asthma Treatment Options
- Inhaled beta-agonists, such as short acting beta-agonists, provide symptom relief with a rapid onset of bronchodilation, and protect against exercise-induced asthma and the early asthmatic response to allergen 2
- Long acting beta-agonists, such as salmeterol and formoterol, provide more prolonged bronchodilation, greater reduction of symptoms, increased lung function and reduced need for short acting beta-agonists 2
- Inhaled corticosteroids (ICSs) decrease the risk of asthma exacerbations, and "as-needed" ICS strategies can improve asthma morbidity outcomes, particularly by reducing severe exacerbations and reducing the risk of adverse effects of oral corticosteroids 3
Combination Therapies
- Combination ICS-formoterol in a single inhaler, ICS and short-acting beta2-agonists in separate inhalers, and combination ICS-albuterol in a single inhaler are effective treatment options for asthma 3
- Salmeterol/fluticasone propionate, a combination of a long-acting beta(2)-adrenoceptor agonist and a corticosteroid, is an effective, well tolerated and cost-effective option for the maintenance treatment of patients with asthma 4
Initial Starting Dose of Inhaled Corticosteroids
- Initial moderate ICS doses appear to be more effective than an initial low ICS dose, and starting with a moderate dose is equivalent to starting with a high dose and stepping down 5
- High doses of ICS are not necessary for most patients, and may increase the risk of side effects without providing additional benefits 5
Oral Corticosteroid-Sparing Effect
- Inhaled fluticasone propionate powder can maintain pulmonary function while reducing the dose of oral prednisone in patients with chronic, severe asthma, and can improve lung function, adrenal function, and asthma-specific quality of life 6