From the Guidelines
The most recent and effective approach to managing asthma is to use a combination of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) for moderate to severe asthma, and as-needed low-dose ICS-formoterol for mild asthma, as recommended by the latest guidelines 1.
Key Recommendations
- Inhaled corticosteroids are the fundamental and first-line therapy in ongoing management because of their proven effectiveness and, in recommended doses, few systemic adverse effects 1.
- Written action plans detailing medications and environmental control strategies tailored for each patient are recommended for all patients with asthma 1.
- The step care of asthma should be based on asthma control, with treatment adjusted in a stepwise approach based on symptom control, and regular reassessment every 3-6 months 1.
Asthma Management
- Asthma control is now weighted equally with asthma severity in determining appropriate therapy, with the recognition that asthma severity can change over time and is most readily recognized by ongoing care of asthma 1.
- Assessment of asthma control should allow for individualization of therapy, taking individual response to treatment into account 1.
- A step down in treatment usually includes decreasing the dose or frequency of medication use, switching from more medications with a higher risk of adverse effects to those with a lower risk of adverse effects, or discontinuing a medication 1.
Treatment Options
- For moderate to severe asthma, daily maintenance ICS-LABA therapy is recommended, with the same combination used as needed for symptom relief 1.
- For mild asthma, the preferred approach is as-needed low-dose ICS-formoterol (such as budesonide-formoterol) as both rescue and controller medication 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
New Asthma Guidelines
- The treatment options for initial maintenance therapy of persistent asthma include inhaled corticosteroids (ICSs) and leukotriene receptor antagonists (LTRAs) 2.
- ICSs are recognized as the cornerstone of asthma therapy and are considered to be the most effective anti-inflammatory medication currently available for the treatment of persistent asthma, regardless of its severity 2.
- LTRAs are also used as initial maintenance therapy in patients whose asthma is uncontrolled by bronchodilators alone 2.
First-Line Treatment for Asthma
- First-line treatment for asthma is inhaled salbutamol, used on demand to relieve respiratory discomfort or to prevent attacks due to a known trigger 3.
- For patients with persistent asthma, treatment is based on daily use of an inhaled corticosteroid such as beclometasone, in combination with inhaled salbutamol if necessary 3.
Combination Therapy
- Asthma guidelines recommend an inhaled corticosteroid plus a long-acting inhaled beta(2)-agonist as the preferred maintenance therapy for moderate and severe persistent asthma 4.
- The combination of salmeterol and fluticasone propionate is a cost-effective treatment option for patients with asthma not controlled with inhaled corticosteroid therapy 4, 5.
- This combination has been shown to be more effective than monotherapy with montelukast or fluticasone propionate in improving lung function and asthma symptoms 2, 6, 5.
Health Care Resource Utilization and Costs
- The use of fluticasone propionate/salmeterol combination has been shown to reduce asthma-related health care resource utilization and costs, and improve adherence to inhaled corticosteroids in children and adults with asthma 6.
- Patients receiving this combination had fewer claims for short-acting beta-agonists, oral corticosteroids, and lower adjusted asthma-related costs compared to those receiving inhaled corticosteroids plus salmeterol or montelukast 6.