Tuberc Respir Dis.  2018 Jan;81(1):1-5. 10.4046/trd.2017.0102.

Add-on Therapy for Symptomatic Asthma despite Long-Acting Beta-Agonists/Inhaled Corticosteroid

Affiliations
  • 1Division of Pneumology, University Hospital RWTH Aachen, Aachen, Germany. mdreher@ukaachen.de

Abstract

Asthma, remains symptomatic despite ongoing treatment with high doses of inhaled corticosteroids (ICS) in conjunction with long-acting beta-agonists (LABA), is classified as "severe" asthma. In the course of caring for those patients diagnosed with severe asthma, stepping up from ICS/LABA to more aggressive therapeutic measures would be justified, though several aspects have to be checked in advance (including inhaler technique, adherence to therapy, and possible associated comorbidities). That accomplished, it would be advisable to step up care in accordance with the Global Initiative for Asthma (GINA) recommendations. Possible strategies include the addition of a leukotriene receptor antagonist or tiotropium (to the treatment regimen). The latter has been shown to be effective in the management of several subgroups of asthma. Oral corticosteroids have commonly been used for the treatment of patients with severe asthma in the past; however, the use of oral corticosteroids is commonly associated with corticosteroid-related adverse events and comorbidities. Therefore, according to GINA 2017 these patients should be referred to experts who specialize in the treatment of severe asthma to check further therapeutic options including biologics before starting treatment with oral corticosteroids.

Keyword

Asthma; Biological Products; Interleukin-5; Immunoglobulin E

MeSH Terms

Adrenal Cortex Hormones
Asthma*
Biological Products
Comorbidity
Humans
Immunoglobulin E
Interleukin-5
Nebulizers and Vaporizers
Receptors, Leukotriene
Tiotropium Bromide
Adrenal Cortex Hormones
Biological Products
Immunoglobulin E
Interleukin-5
Receptors, Leukotriene
Tiotropium Bromide
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