As-needed inhaled corticosteroids in asthma: from evidence to implementation

Area of Science:

• Pulmonology
• Pharmacology
• Asthma Management

Background:

• Recent guidelines recommend inhaled corticosteroid (ICS) with a fast-acting bronchodilator as the preferred asthma treatment.
• Short-acting beta agonist (SABA) monotherapy is no longer recommended for asthma management.
• The US Food and Drug Administration (FDA) recently approved a new ICS/SABA combination inhaler.

Purpose of the Study:

• To clarify the role of as-needed ICS across adult asthma severity.
• To explore implementation challenges of ICS-based asthma management.
• To review the impact of recent FDA approval of ICS/SABA inhalers.

Main Methods:

• Literature review of current asthma guidelines and treatment strategies.
• Analysis of recent recommendations from GINA and NHLBI.
• Exploration of barriers and facilitators for implementing new asthma treatment paradigms.

Main Results:

• Global Initiative for Asthma (GINA) and US National Heart, Lung, and Blood Institute (NHLBI) guidelines now endorse ICS-based strategies.
• The use of ICS/formoterol for maintenance and reliever therapy (MART) is recommended.
• Despite recommendations, the adoption of these ICS strategies in the US has been slow, with identified implementation barriers.

Conclusions:

• A single ICS/formoterol inhaler for MART offers potential multidomain benefits over traditional multi-inhaler regimens.
• The clinical utility of new ICS/SABA combination inhalers requires further investigation across the asthma spectrum.
• Optimizing ICS use is crucial for improving asthma control and patient outcomes.