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Achieving asthma control in patients with moderate disease
J Mark FitzGerald1, Neal Shahidi
1University of British Columbia Respiratory Division and the Centre for Lung Health, University of British Columbia, Vancouver, British Columbia, Canada. markf@interchange.ubc.ca
The Journal of Allergy and Clinical Immunology
|February 18, 2010
Summary
For moderate asthma, initial treatment with inhaled corticosteroids (ICS) and rescue inhalers works for most. Uncontrolled symptoms may require adding long-acting beta-agonists or increasing ICS dosage.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Moderate asthma presents ongoing symptoms despite initial treatment.
- Standard initial therapy involves low-dose inhaled corticosteroids (ICS) and short-acting bronchodilators.
- Many patients achieve control with this regimen, but some require further intervention.
Purpose of the Study:
- To outline management strategies for patients with moderate asthma experiencing uncontrolled symptoms.
- To identify effective add-on therapies and treatment adjustments for persistent asthma.
- To emphasize the importance of patient education and action plans in asthma management.
Main Methods:
- Review of current treatment guidelines and clinical evidence for moderate asthma.
- Analysis of therapeutic options including inhaled corticosteroids (ICS), long-acting beta-adrenergic agonists (LABAs), and leukotriene receptor antagonists (LTRAs).
- Consideration of factors like adherence, inhaler technique, and comorbidities.
Main Results:
- For steroid-naive patients, initial low-dose ICS plus a rescue inhaler is often effective.
- For uncontrolled symptoms, adding a long-acting beta-adrenergic agonist (LABA) or increasing ICS dosage is recommended.
- Leukotriene receptor antagonists (LTRAs) can be used as alternative initial therapy or add-on treatment.
- Quadrupling the maintenance ICS dose is a highly effective strategy for worsening symptoms.
Conclusions:
- Comprehensive management of moderate asthma involves optimizing initial therapy and considering add-on treatments.
- Structured patient education and written action plans are crucial for effective long-term asthma control.
- Adjusting ICS dosage, adding LABAs, or considering LTRAs are key strategies for persistent symptoms.
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