Considerations in the long-term management of asthma in ambulatory patients

The goals of treatment and drug therapies used for long-term asthma control, classification of the disease by severity, and treatment based on severity are reviewed, with an emphasis on recent controversies in treatment approach and safety concerns.

Patient education and written asthma self-management and action plans are essential components of asthma treatment because of the need for patients to acquire substantial knowledge and skills in self-care. Inhaled corticosteroids are the most effective long-term-control therapy and usually suffice as monotherapy for mild persistent asthma. Adding a long-acting, inhaled beta2 agonist to the inhaled corticosteroid is preferred for moderate and severe persistent disease despite safety concerns. Omalizumab use is limited to selected patients with moderate-to-severe allergic asthma and an inadequate response to inhaled corticosteroids.

The long-term control of asthma requires substantial patient knowledge and skill. Persistent disease is best managed by inhaled corticosteroids and if it is moderate or severe, long-acting, inhaled beta2 agonists in combination with inhaled corticosteroids.