Asthma Guidelines Priority Topic: Long-Acting Anti-Muscarinic Agents in Asthma Management as Add-On to Inhaled Corticosteroids

2018 ◽  
Vol 31 (3) ◽  
pp. 199-203 ◽  
Author(s):  
Kathryn V. Blake ◽  
Hengameh H. Raissy
Keyword(s):  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Long Acting ◽  
Muscarinic Agents

scholarly journals Adult Asthma Consensus Guidelines Update 2003

2004 ◽  
Vol 11 (suppl a) ◽  
pp. 9A-18A ◽  
Author(s):  
Catherine Lemière ◽  
Tony Bai ◽  
Meyer Balter ◽  
Charles Bayliff ◽  
Allan Becker ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Present Report ◽  
Asthma Management ◽  
Consensus Guidelines ◽  
Asthma Education ◽  
Adult Asthma ◽  
Early Introduction ◽  
Long Acting ◽  
New Evidence ◽  
Consensus Report

BACKGROUND: Several sets of Canadian guidelines for the diagnosis and management of asthma have been published over the past 15 years. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies have highlighted the need to incorporate new information into the asthma guidelines.OBJECTIVES: To review the literature on adult asthma management published between January 2000 and June 2003; to evaluate the influence of the new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Guidelines and its 2001 update; and to report new recommendations on adult asthma management.METHODS: Three specific topics for which new evidence affected the previous recommendations were selected for review: initial treatment of asthma, add-on therapies in the treatment of asthma and asthma education. The resultant reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Thoracic Society, and recommendations for adult asthma management were reviewed.RESULTS: The present report emphasises the importance of the early introduction of inhaled corticosteroids in symptomatic patients with mild asthma; stresses the benefit of adding additional therapy, preferably long-acting beta2-agonists, to patients incompletely controlled on low doses of inhaled corticosteroids; and documents the essential role of asthma education.CONCLUSION: The present report generally supports many of the previous recommendations published in the 1999 Canadian Asthma Consensus Report and provides higher levels of evidence for a number of those recommendations.

scholarly journals Comparing LAMA with LABA and LTRA as add-on therapies in primary care asthma management

2020 ◽  
Vol 30 (1) ◽  
Author(s):  
Alan Kaplan ◽  
J. Mark FitzGerald ◽  
Roland Buhl ◽  
Christian Vogelberg ◽  
Eckard Hamelmann
Keyword(s):  
Primary Care ◽  
Lung Function ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Global Initiative For Asthma ◽  
Control Asthma ◽  
Global Initiative ◽  
Long Acting ◽  
Randomised Controlled ◽  
Meta Analyses

Abstract The Global Initiative for Asthma recommends a stepwise approach to adjust asthma treatment to the needs of individual patients; inhaled corticosteroids (ICS) remain the core pharmacological treatment. However, many patients remain poorly controlled, and evidence-based algorithms to decide on the best order and rationale for add-on therapies are lacking. We explore the challenges of asthma management in primary care and review outcomes from randomised controlled trials and meta-analyses comparing the long-acting muscarinic antagonist (LAMA) tiotropium with long-acting β2-agonists (LABAs) or leukotriene receptor antagonists (LTRAs) as add-on to ICS in patients with asthma. In adults, LAMAs and LABAs provide a greater improvement in lung function than LTRAs as add-on to ICS. In children, results were positive and comparable between therapies, but data are scarce. This information could aid decision-making in primary care, supporting the use of add-on therapy to ICS to help improve lung function, control asthma symptoms and prevent exacerbations.

scholarly journals Inhaled Formoterol-Fluticasone Single Inhaler Therapy in Asthma: Real-World Efficacy, Budget Impact, and Potential to Improve Adherence

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
V. Rajesh ◽  
Jolsana Augustine ◽  
R. Divya ◽  
Melcy Cleetus
Keyword(s):  
Real World ◽  
Disease Burden ◽  
Budget Impact ◽  
Inhaled Corticosteroids ◽  
Therapeutic Option ◽  
Asthma Management ◽  
First Line ◽  
Advantageous Position ◽  
Long Acting ◽  
Practical Recommendations

Asthma is the commonest chronic disease affecting airways in humans and has an increasing global disease burden. Inhaled corticosteroids (ICS) are the first-line therapeutic option for asthma, and addition of a long-acting beta 2-agonist (LABA) has been shown to improve asthma control. A combination of the two agents in a single inhaler is beneficial with regard to ease of administration and patient compliance. Various ICS-LABA formulations are available across various countries in the world, one among them being formoterol-fluticasone. Both formoterol and fluticasone have pharmacologic peculiarities which places the combination in a uniquely advantageous position when it comes to asthma therapy. The present review focuses on some of the, hitherto, less explored aspects of this combination inhaler such as real-world efficacy, impact on budget allocation, results of switch-over therapy, and potential to improve adherence to asthma treatment. It also provides practical recommendations on positioning it in real-world asthma management.

scholarly journals Canadian Thoracic Society Asthma Management Continuum – 2010 Consensus Summary for Children Six Years of Age and Over, and Adults

2010 ◽  
Vol 17 (1) ◽  
pp. 15-24 ◽  
Author(s):  
M Diane Lougheed ◽  
Catherine Lemière ◽  
Sharon D Dell ◽  
Francine M Ducharme ◽  
J Mark FitzGerald ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Immunoglobulin E ◽  
Action Plan ◽  
Age Groups ◽  
Asthma Management ◽  
Accurate Diagnosis ◽  
Objective Measures ◽  
High Dose ◽  
Adult Asthma ◽  
Long Acting

BACKGROUND/OBJECTIVE: To integrate new evidence into the Canadian Asthma Management Continuum diagram, encompassing both pediatric and adult asthma.METHODS: The Canadian Thoracic Society Asthma Committee members, comprised of experts in pediatric and adult respirology, allergy and immunology, emergency medicine, general pediatrics, family medicine, pharmacoepidemiology and evidence-based medicine, updated the continuum diagram, based primarily on the 2008 Global Initiative for Asthma guidelines, and performed a focused review of literature pertaining to key aspects of asthma diagnosis and management in children six years of age and over, and adults.RESULTS: In patients six years of age and over, management of asthma begins with establishing an accurate diagnosis, typically by supplementing medical history with objective measures of lung function. All patients and caregivers should receive self-management education, including a written action plan. Inhaled corticosteroids (ICS) remain the first-line controller therapy for all ages. When asthma is not controlled with a low dose of ICS, the literature supports the addition of long-acting beta2-agonists in adults, while the preferred approach in children is to increase the dose of ICS. Leukotriene receptor antagonists are acceptable as second-line monotherapy and as an alternative add-on therapy in both age groups. Anti-immunoglobulin E therapy may be of benefit in adults, and in children 12 years of age and over with difficult to control allergic asthma, despite high-dose ICS and at least one other controller.CONCLUSIONS: The foundation of asthma management is establishing an accurate diagnosis based on objective measures (eg, spirometry) in individuals six years of age and over. Emphasis is placed on the similarities and differences between pediatric and adult asthma management approaches to achieve asthma control.

scholarly journals Management of Asthma with ICS and LABAs: Different treatment strategies

2009 ◽  
Vol 1 ◽  
pp. CMT.S2283
Author(s):  
M Van Den Berge ◽  
NHT Ten Hacken ◽  
HAM Kerstjens ◽  
DS Postma
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Asthma Management ◽  
Treatment Strategies ◽  
Rapid Onset ◽  
Onset Of Action ◽  
Persistent Symptoms ◽  
Patient Symptom ◽  
Asthma Patients ◽  
Long Acting

In recent years considerable insight has been gained in the optimal management of adult asthma. In asthma patients who have persistent symptoms despite the daily use of (a low dose) inhaled corticosteroids (ICS), adding a long-acting β2-agonist to ICS improves asthma control and decreases the number of exacerbations. Currently two different LABAs are available, ie formoterol and salmeterol. The most important difference between both LABAs is a more rapid onset of action of formoterol (2-5 minutes) when compared to salmeterol (15-30 minutes). Partly based on these pharmacological differences, two major different approaches have been put forward to asthma management. The first approach (Gaining Optimal Asthma Control) is promoted by the producers of fluticasone/salmeterol and recommends to step up ICS to the dose needed to achieve optimal asthma control in order to keep the patient symptom free and to prevent exacerbations. The second approach is promoted by the producers of budesonide/formoterol and recommends a low maintenance dose which can be adjusted up or down according to the clinical control of asthma. Initially, a treatment strategy with Adjustable Maintenance Dosing with budesonide/formoterol was introduced. At a later time, this concept was changed to the Symbicort Maintenance And Reliever Therapy (SMART) approach. The aim of this manuscript is to review the current literature on the management of asthma with ICS and LABAs and to discuss the different treatment strategies.

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