What are the guidelines for treating reactive airway disease, also known as bronchial hyperreactivity or asthma?

From the Guidelines

Reactive airway disease treatment should prioritize a stepwise approach, starting with short-acting beta-agonists for acute symptoms and inhaled corticosteroids for persistent symptoms, with combination inhalers and leukotriene modifiers considered for moderate to severe cases, as recommended by the most recent guidelines 1.

Treatment Approach

The treatment of reactive airway disease (RAD) focuses on reducing inflammation and relieving bronchospasm. For acute symptoms, short-acting beta-agonists like albuterol (2-4 puffs every 4-6 hours as needed) provide quick relief by relaxing airway muscles.

Medication Options

For persistent symptoms, inhaled corticosteroids such as fluticasone (88-440 mcg twice daily) or budesonide (180-360 mcg twice daily) are the cornerstone of treatment, reducing inflammation over time.

• Combination inhalers containing both a long-acting beta-agonist and corticosteroid (like fluticasone/salmeterol or budesonide/formoterol) may be used for moderate to severe cases.
• Leukotriene modifiers such as montelukast (10mg daily for adults) can supplement inhaled treatments.
• For severe exacerbations, oral corticosteroids like prednisone (40-60mg daily for 5-7 days) may be necessary, as suggested by guidelines for managing asthma during pregnancy 1.

Patient Education and Prevention

Proper inhaler technique is crucial for medication effectiveness—patients should activate the inhaler while beginning a slow, deep breath and hold for 10 seconds.

• Identifying and avoiding triggers (allergens, irritants, cold air, exercise) is essential for prevention.
• Treatment should be stepped up or down based on symptom control, with the goal of using the minimum effective medication, as emphasized in the latest NAEPP guidelines 1. These medications work by targeting different aspects of the inflammatory cascade and smooth muscle contraction that cause airway narrowing and symptoms like wheezing, coughing, and shortness of breath.

Key Considerations

The intensity of treatment will depend on the severity of exacerbation, and up to 3 treatments at 20-minute intervals or a single nebulizer treatment as needed may be necessary, as indicated in the NAEPP expert panel report 1.

• Patient education, like patients with diabetes, patients with asthma must take responsibility for day-to-day management, and monitoring of pulmonary function is essential, as highlighted in a study on inhaled corticosteroids 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. • Maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD).

The guidelines for treating reactive airway disease, as indicated by the FDA drug label for Wixela Inhub, include:

• Twice-daily treatment of asthma in patients aged 4 years and older with Wixela Inhub.
• Maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD). Key points to consider:
• Dosage: 1 inhalation of Wixela Inhub 100/50, Wixela Inhub 250/50, or Wixela Inhub 500/50 twice daily, based on asthma severity.
• Contraindications: Primary treatment of status asthmaticus or acute episodes of asthma or COPD requiring intensive measures, and severe hypersensitivity to milk proteins or demonstrated hypersensitivity to fluticasone propionate, salmeterol, or any of the excipients.
• Warnings and Precautions: LABA monotherapy increases the risk of serious asthma-related events, and do not initiate in acutely deteriorating asthma or COPD. 2

From the Research

Treatment Guidelines for Reactive Airway Disease

• The treatment of reactive airway disease, such as asthma, typically involves the use of bronchodilators, including short-acting beta-agonists (SABAs) and long-acting beta-agonists (LABAs) 3.
• SABAs, such as salbutamol, provide quick relief of symptoms, but their regular use as maintenance therapy is not recommended due to the risk of increased airway hyper-responsiveness and decreased control of asthma 3.
• LABAs, such as salmeterol and formoterol, provide more prolonged bronchodilation and are recommended for individuals whose asthma is not well-controlled on moderate doses of inhaled corticosteroids 3, 4.
• The combination of inhaled corticosteroids and LABAs is recommended for the treatment of persistent asthma, and has been shown to provide 24-hour improvement in lung function in adult asthmatic patients 4.

Use of Cardioselective Beta-Blockers

• Cardioselective beta-blockers have been shown to be safe for use in patients with mild to moderate reactive airway disease, and do not produce clinically significant adverse respiratory effects 5, 6.
• These beta-blockers can be used in patients with reversible airway disease, including asthma and chronic obstructive pulmonary disease (COPD), without increasing the risk of respiratory symptoms or decreasing lung function 5, 6.

Pharmacological Profile of Salbutamol

• Salbutamol is a selective short-acting β2-agonist (SABA) used as an alternative reliever in the treatment of asthma, with a therapeutic effect based on its potent smooth muscle relaxant properties 7.
• The pharmacokinetic parameters of salbutamol, including absorption, distribution, metabolism, and elimination, vary depending on the formulation, and can affect its efficacy and adverse effects 7.