Clinical implications of combination therapy on the future of asthma management

Current guidelines for the treatment of moderate persistent asthma list the combination of long-acting beta-agonists and inhaled corticosteroids (ICSs) as the treatment of choice. This decision is based on their efficacy compared with other dual controller combinations such as increased doses of ICSs or adding leukotriene modifiers, especially when the forced expiratory volume in 1 second value is used as the primary comparator. The main purpose of this study is to examine this form of dual controller therapy in terms of anti-inflammatory effects. One of the concerns with the combination of long-acting beta-agonists and ICSs is what happens to patients on this therapy during an asthma exacerbation. The existing data indicate that when combination therapy was compared with high-dose ICSs alone, it did not alter the ability to detect deteriorating asthma, it led to faster recovery after an exacerbation, it did not disguise deteriorating asthma, and it did not increase/mask airway inflammation. This study also examines how to approach patients placed on this dual controller therapy after control of their asthma is attained. Suggestions for the transition from initial therapy to maintenance therapy that may involve single controller medications are made. Innovative methods of handling asthma exacerbations with dual controller therapy also are made.