From the Guidelines
Asthma is a heterogeneous disease characterized by chronic airway inflammation, variable expiratory airflow limitation, and symptoms such as wheeze, shortness of breath, chest tightness, and cough, and should be treated with inhaled corticosteroids (ICS) combined with long-acting β2-adrenergic agonists (LABA) as the cornerstone of treatment.
Definition and Pathophysiology
Asthma is defined by the history of respiratory symptoms that vary over time and in intensity, together with variable expiratory airflow limitation 1. The disease is characterized by chronic airway inflammation, and separate phenotypes exist, influenced by both environment and genetic predisposition 1.
Treatment
The treatment of asthma typically involves a combination of quick-relief and long-term control medications. For long-term control, inhaled corticosteroids such as fluticasone or budesonide are commonly prescribed to reduce inflammation, and may be combined with long-acting beta-agonists like salmeterol or formoterol 1. Leukotriene modifiers like montelukast may also be used. Proper inhaler technique is crucial for medication effectiveness.
Management
Patients should identify and avoid personal asthma triggers such as allergens, exercise, cold air, or respiratory infections. Creating an asthma action plan with a healthcare provider helps manage symptoms effectively and know when to seek emergency care. Regular follow-ups are important to adjust medication as needed, as asthma severity can change over time.
Key Considerations
- Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation 1.
- The interaction of these features determines the clinical manifestations and severity of asthma and the response to treatment.
- Airflow limitation is caused by a variety of changes in the airway, all influenced by airway inflammation, including bronchoconstriction, airway hyperresponsiveness, and airway edema 1.
From the FDA Drug Label
Asthma is a continuing (chronic) inflammation of the bronchial passageways which are the tubes that carry air from outside the body to the lungs Symptoms of asthma include: coughing wheezing chest tightness shortness of breath For exercise-induced asthma - Take at least 2 hours before exercise, but not more than once daily: One 10-mg tablet for adults and adolescents 15 years of age and older
Asthma Treatment with Montelukast: Montelukast is used to treat asthma, including exercise-induced asthma. The recommended dose for exercise-induced asthma is 10 mg taken at least 2 hours before exercise, but not more than once daily, for adults and adolescents 15 years of age and older.
- Key Points:
- Asthma is a chronic inflammation of the bronchial passageways
- Symptoms of asthma include coughing, wheezing, chest tightness, and shortness of breath
- Montelukast is used to treat asthma, including exercise-induced asthma 2
From the Research
Asthma Management
- Asthma is a chronic respiratory disease that requires effective management to prevent severe exacerbations and improve quality of life 3.
- Inhaled corticosteroids (ICS) are a key component of asthma management, as they decrease the risk of asthma exacerbations and improve lung function 3, 4, 5.
- However, patient adherence to ICS-containing medications as daily maintenance therapy is often poor, and many patients overuse short-acting beta2-agonist relievers, which can increase the risk of severe exacerbations and death 3.
Inhaled Corticosteroid Dosing
- The optimal starting dose of ICS for asthma in adults is a topic of debate, with some studies suggesting that a moderate dose is equivalent to a high dose and stepping down 5.
- A systematic review of randomized controlled trials found that starting with a moderate dose of ICS is more effective than starting with a low dose, and is equivalent to starting with a high dose and stepping down 5.
- Another study found that 200 μg/day of fluticasone propionate was as effective as 1000 μg/day in improving asthma control, airway inflammation, lung function, and airway hyperresponsiveness in adults with mild or moderate asthma 4.
Combination Therapies
- Combination therapies, such as salmeterol/fluticasone propionate, have been shown to be effective in improving lung function and symptoms, and are as well tolerated as concurrent salmeterol plus fluticasone propionate 6.
- A novel multidose dry powder inhaler (MDPI) has been developed, which allows for lower doses of fluticasone propionate and fluticasone propionate/salmeterol for the treatment of patients with asthma 7.
- Studies have shown that MDPIs are effective in improving lung function and symptoms, and are well tolerated in patients with persistent asthma 7.
Treatment Outcomes
- Effective asthma management can improve quality of life, reduce the risk of severe exacerbations, and decrease healthcare utilization 3, 6, 7.
- Improving access to effective asthma treatments, such as ICS and combination therapies, is imperative to improve asthma outcomes and achieve equity across populations 3.