What are the differences between mild and moderate asthma exacerbations related to seasonal allergic (allergenic) rhinitis?

From the Guidelines

Mild and moderate asthma related to seasonal allergies differ significantly in terms of symptom severity, frequency, and treatment approaches, with moderate asthma requiring more intensive management to control symptoms and prevent exacerbations. The key differences between mild and moderate asthma lie in the frequency and severity of symptoms, with mild asthma characterized by symptoms occurring less than twice weekly and moderate asthma involving more frequent symptoms and some activity limitations.

Treatment Approaches

• In mild asthma, patients typically manage with as-needed short-acting beta-agonists (SABAs) like albuterol (2 puffs every 4-6 hours as needed) 1.
• Moderate asthma, on the other hand, requires daily controller medications such as low-dose inhaled corticosteroids (like fluticasone 88-220 mcg twice daily or budesonide 180-360 mcg twice daily) plus a SABA for breakthrough symptoms 1.

Seasonal Allergy-Triggered Asthma

• Both mild and moderate asthma benefit from allergen avoidance, antihistamines (cetirizine 10mg or loratadine 10mg daily), and nasal corticosteroids (fluticasone nasal spray 1-2 sprays per nostril daily) during allergy seasons 1.
• The combination of intranasal and inhaled glucocorticosteroids (fluticasone) is often necessary to control the seasonal increase in nasal and asthmatic symptoms in patients with pollen-induced rhinitis and asthma 1.

Monitoring and Adjusting Treatment

• Regular peak flow monitoring can help patients track their asthma status, with readings below 80% of personal best indicating worsening control that may require treatment adjustment.
• The progression from mild to moderate asthma often reflects increasing airway inflammation and hyperresponsiveness due to repeated allergen exposure, which causes structural changes in airways over time 1.

From the FDA Drug Label

The patients studied were mild and moderate, non-smoking asthmatics who required approximately 5 puffs of inhaled β-agonist per day on an “as-needed” basis The efficacy of SINGULAIR for the chronic treatment of asthma in adults and adolescents 15 years of age and older was demonstrated in two (U. S. and Multinational) similarly designed, randomized, 12-week, double-blind, placebo-controlled trials in 1576 patients

The difference between mild and moderate asthma related to seasonal allergies is not explicitly described in terms of specific characteristics or symptoms. However, the drug label mentions that the patients studied were mild and moderate, non-smoking asthmatics who required approximately 5 puffs of inhaled β-agonist per day on an “as-needed” basis.

• Mild asthma is not further defined in the label.
• Moderate asthma is also not further defined in the label. The label does provide information on the efficacy of montelukast in patients with asthma, including those with seasonal allergic rhinitis 2.

From the Research

Difference between Mild and Moderate Asthma

• Mild asthma is characterized by symptoms that occur twice a week or less, with nighttime symptoms occurring twice a month or less 3.
• Moderate asthma is characterized by symptoms that occur more frequently, with nighttime symptoms occurring more than twice a month 3.

Seasonal Allergies and Asthma

• Seasonal allergies can trigger asthma symptoms, and patients with asthma may experience worsening symptoms during peak allergy seasons 4.
• Inhaled corticosteroids (ICS) are a common treatment for asthma, and may be used in combination with long-acting beta-agonists (LABAs) for patients with moderate to severe asthma 5, 6, 7.

Treatment Options

• For patients with mild asthma, treatment may involve the use of short-acting beta-agonists (SABAs) as needed, with the addition of ICS or ICS/LABA combination therapy if symptoms persist 3, 4.
• For patients with moderate asthma, treatment may involve the use of ICS/LABA combination therapy, with the option to add additional medications such as montelukast or adjust the dose of ICS/LABA as needed 5, 6, 7.

Key Considerations

• The choice of treatment should be based on the individual patient's needs and medical history, with consideration given to the potential risks and benefits of each treatment option 5, 3, 6, 7, 4.
• Patients with asthma should work with their healthcare provider to develop a personalized treatment plan, including a written asthma action plan to help manage symptoms and prevent exacerbations 4.