What are the treatment options for asthma?

From the Guidelines

Asthma treatment should prioritize inhaled corticosteroids as the most potent and consistently effective long-term control medication, with oral systemic corticosteroids recommended for moderate to severe asthma exacerbations. The treatment of asthma focuses on controlling symptoms and preventing exacerbations through a stepwise approach [ 1 ]. For mild intermittent asthma, short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) are the primary treatment. For persistent asthma, inhaled corticosteroids (ICS) form the cornerstone of therapy, with medications like fluticasone (100-500 mcg twice daily) or budesonide (180-720 mcg twice daily) [ 1 ].

Key Considerations

• Inhaled corticosteroids are the preferred treatment for long-term control of asthma, with leukotriene receptor antagonists as an alternative for mild persistent asthma [ 1 ].
• Long-acting beta-agonists (LABAs) are not recommended for use as monotherapy for long-term control of persistent asthma, but can be used as an adjunct to inhaled corticosteroid therapy [ 1 ].
• Increasing the use of short-acting beta2 agonists or using them more than two days per week for symptom relief generally indicates inadequate control of asthma and the need to initiate or intensify anti-inflammatory therapy [ 1 ].

Treatment Approach

The stepwise approach for managing asthma involves evaluating asthma control in 2 to 6 weeks and classifying the level of asthma control by the most severe indicator of impairment or risk [ 1 ]. The treatment plan should be adjusted based on symptom control, with the goal of using the lowest effective dose to maintain control while minimizing side effects. All patients should have an asthma action plan and a rescue inhaler.

Additional Options

For moderate to severe asthma, additional options include leukotriene modifiers (montelukast 10mg daily), long-acting muscarinic antagonists (tiotropium 2.5 mcg daily), and biologics for severe eosinophilic asthma (omalizumab, mepolizumab, or dupilumab) [ 1 ]. Regular follow-up is essential to adjust therapy based on symptom control and to minimize side effects.

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)

Treatment of Asthma: Wixela Inhub® is indicated for the twice-daily treatment of asthma in patients aged 4 years and older. The dosage is based on asthma severity, with different inhalation options for patients aged 12 years and older (Wixela Inhub® 100/50, Wixela Inhub® 250/50, or Wixela Inhub® 500/50) and patients aged 4 to 11 years (Wixela Inhub® 100/50). 2

From the Research

Treatment of Asthma

• The treatment of asthma typically involves the use of inhaled corticosteroids (ICS) and long-acting inhaled beta-agonists (LABAs) 3, 4.
• International guidelines recommend the early introduction of ICS and their regular use to gain clinical and functional control of persistent asthma 3.
• The optimal starting dose of ICS for asthma in adults is a moderate dose, which appears to be more effective than an initial low ICS dose 5.
• Initial moderate ICS doses are equivalent to starting with a high dose and stepping down, with no significant difference in lung function, symptoms, or rescue medications between the two treatment approaches 5.
• The use of fluticasone and formoterol appears to provide improved therapeutic benefits versus budesonide and salmeterol, respectively 4.
• Combination therapies, such as fluticasone/salmeterol and budesonide/formoterol, are associated with greater improvements in outcomes measures than the corresponding ICS and LABA monotherapies 4.
• Intermittent ICS therapy has been successfully used in the long-term treatment of mild asthma, and twice-daily administration of ICS provides greater therapeutic benefit than a once-daily regimen in moderate asthma 3.
• Chlorofluorocarbon-free formulations of old ICS have also remarkably improved their clinical efficacy mainly through an increased peripheral deposition pattern 3.
• Patient education and compliance are crucial in maximizing the benefits of ICS therapy, and new ICS with better drug delivery and topical potency are being developed 6.
• The combination of salmeterol and fluticasone propionate has been shown to improve asthma control greater than monotherapy with the individual agents alone, with no additional safety risk 7.