From the Guidelines
I strongly recommend adjusting your current asthma management plan to better control your worsening symptoms, focusing on maximizing the benefits of your existing medications and considering additional therapies as needed, based on the most recent guidelines and evidence from 1 and 1.
Current Medication Assessment
You are currently taking Advair twice daily, which contains a corticosteroid to reduce inflammation and a long-acting bronchodilator to keep airways open, and Ventolin as needed for immediate symptom relief.
- The use of Advair is in line with recommendations for moderate to severe persistent asthma, as outlined in 1.
- However, if you're using Ventolin more than twice weekly, this indicates your asthma is not well controlled, suggesting the need for adjustment in your long-term control medications.
Adjustment Recommendations
- Continue your Advair twice daily but consider increasing to a higher strength if available, as higher doses of ICSs may provide additional benefit for some patients, although the risk of systemic effects also increases, as noted in 1.
- Use your Ventolin (albuterol) rescue inhaler as needed for immediate symptom relief.
- Consider adding a daily oral leukotriene modifier like montelukast (Singulair) 10mg taken in the evening to help reduce inflammation, as adjunctive therapies can provide additional benefits for patients with poorly controlled asthma, as discussed in 1.
Monitoring and Lifestyle Adjustments
- Monitor your peak flow readings daily to track lung function.
- Avoid known triggers such as allergens, smoke, or cold air.
- If symptoms persist despite these adjustments, you may need a short course of oral corticosteroids or the addition of a biologic therapy, as worsening asthma symptoms can indicate a need for more intensive treatment, as suggested by 1 and 1.
Urgent Situations
Contact your healthcare provider immediately if you experience severe shortness of breath, inability to speak in full sentences, or if your rescue inhaler isn't providing relief, as these can be signs of a severe asthma exacerbation requiring prompt medical attention.
From the FDA Drug Label
Asthma symptoms2.97.23.3 The FDA drug label does not answer the question.
From the Research
Current Treatment and Symptoms
- The patient is currently taking Advair (fluticasone and salmeterol) twice daily and Ventolin (albuterol) as needed for asthma symptoms.
- The patient reports worsening asthma symptoms.
Treatment Options
- According to the 2020 Asthma Guideline Update 2, a short-term increase in the inhaled corticosteroid (ICS) dose alone for worsening of asthma symptoms is not recommended.
- The guidelines recommend adding a long-acting muscarinic antagonist (LAMA) to ICS-formoterol therapy for patients with moderate to severe persistent asthma whose symptoms are not controlled by ICS-formoterol therapy.
- Studies have shown that LAMAs are effective as add-on therapy to ICS plus long-acting β2-agonist (LABA) combinations in patients with moderate to severe uncontrolled asthma 3, 4, 5.
- Single-inhaler triple therapy with ICS, LABA, and LAMA has been shown to be effective in improving lung function and reducing exacerbations in patients with asthma 6, 4, 5.
Potential Next Steps
- Consider adding a LAMA to the patient's current treatment regimen, as recommended by the guidelines and supported by evidence from studies 2, 3, 4, 5.
- Monitor the patient's symptoms and lung function to determine the effectiveness of the treatment and make adjustments as needed.
- Consider switching to a single-inhaler triple therapy with ICS, LABA, and LAMA, which has been shown to be effective in improving lung function and reducing exacerbations in patients with asthma 6, 4, 5.