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Use of ICS and Fast-Acting Bronchodilators in Asthma: Past, Present, and Future
Insights
Primary care asthma management faces challenges, but new inhaled corticosteroid (ICS) and short-acting beta2-agonist (SABA) rescue inhalers offer improved control and reduced exacerbations. This advances asthma treatment by leveraging rapid ICS action and patient preferences.
Area of Science:
- Pulmonology
- Primary Care Medicine
- Pharmacology
Background:
- Most asthma patients are managed in primary care, yet significant gaps in care persist, leading to high exacerbation rates.
- Challenges include uncontrolled asthma, inadequate assessment, over-reliance on short-acting beta2-agonists (SABAs) or systemic corticosteroids (SCS), and poor adherence to maintenance therapy.
- Recent evidence shows inhaled corticosteroids (ICS) have a rapid onset of action, challenging previous assumptions.
Purpose of the Study:
- To review current challenges in asthma management within primary care settings.
- To highlight the rapid onset of action of ICS and the benefits of ICS + fast-acting bronchodilator treatments for symptom relief and exacerbation reduction.
- To emphasize the importance of patient-centered care and the recent approval of a SABA-ICS combination rescue inhaler.
Main Methods:
- Review of current literature on asthma management, exacerbations, and treatment strategies.
- Analysis of the role of inhaled corticosteroids (ICS) and their onset of action.
- Discussion of the implications of a newly approved SABA-ICS combination rescue inhaler.
Main Results:
- Inhaled corticosteroids (ICS) demonstrate rapid action on bronchial tissue, occurring within seconds to minutes.
- Combination therapy with ICS and fast-acting bronchodilators, used as needed for symptoms, improves asthma control and lowers exacerbation rates.
- A SABA-ICS combination inhaler for as-needed use was approved in January 2023 to reduce exacerbation risk.
Conclusions:
- Early intervention with ICS + fast-acting bronchodilators during symptom onset can prevent exacerbations and decrease reliance on systemic corticosteroids (SCS).
- Incorporating patient preferences into asthma management plans enhances engagement and improves outcomes.
- The advent of SABA-ICS combination rescue inhalers represents a significant advancement in managing asthma and preventing exacerbations in primary care.
Key Takeaways:
Primary care practitioners (PCPs) play a key role in asthma management since most patients with asthma are treated in primary care settings. Despite continual advances in asthma care, important practice gaps remain, and the high burden of asthma exacerbations persists, with 43% of children with asthma and 41% of adults with asthma in the United States experiencing an asthma exacerbation in 2020. Uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, reliance on systemic corticosteroids (SCS) or short-acting beta2-agonist (SABA)-only therapy, and lack of patient adherence to anti-inflammatory maintenance therapies are challenges clinicians face today with asthma care. Inhaled corticosteroids (ICS) have been thought to have slow onset of action; however, recent data indicate that ICS onset of action on bronchial tissue is seconds to minutes through nongenomic effects. A large body of evidence supports the use of ICS + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations. The symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS + fast-acting bronchodilators, potentially preventing the exacerbation and reducing the need for SCS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved outcomes. In January 2023, a SABA-ICS combination rescue inhaler was approved by the US Food and Drug Administration (FDA) as the first asthma rescue inhaler for as-needed use to reduce the risk of exacerbations.
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