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"As-Needed" Inhaled Corticosteroids for Patients With Asthma
Juan Carlos Cardet1, Alberto Papi2, Helen K Reddel3
1Division of Allergy and Immunology, Internal Medicine Department, Morsani College of Medicine, University of South Florida, Tampa, Fla.
The Journal of Allergy and Clinical Immunology. in Practice
|January 26, 2023
Summary
As-needed inhaled corticosteroids (ICSs) strategies can reduce severe asthma exacerbations and oral corticosteroid use. This review examines evidence for various ICS-based reliever inhaler strategies to improve asthma management.
Area of Science:
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Poor adherence to daily inhaled corticosteroids (ICSs) and overuse of short-acting beta2-agonists are linked to severe asthma exacerbations.
- Airway inflammation fluctuates due to environmental and infectious triggers, necessitating adaptive treatment approaches.
Approach:
- This review synthesizes evidence on as-needed ICS strategies, including ICS-formoterol, ICS/SABA, and ICS-albuterol combinations.
- Evidence is presented for different asthma severity levels and age groups, considering practical implementation.
Key Points:
- As-needed ICS strategies empower patients to manage symptom fluctuations and reduce exacerbation risk.
- These strategies can decrease severe asthma exacerbations and reliance on oral corticosteroids.
- The review evaluates combination inhaler devices and separate inhaler approaches.
Conclusions:
- As-needed ICS strategies offer a promising approach to improve asthma morbidity and reduce exacerbation-related risks.
- Global access to these adaptive ICS strategies is crucial for equitable asthma care.
- Further research is needed to address evidence gaps and optimize clinical practice.
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