The pharmacologic treatment of asthma is based on stepwise therapy. Asthma medications should be added or discontinued as the frequency and severity of the patient's symptoms change.
Step 1—Intermittent asthma: A controller medication is not indicated. The reliever medication is a short-acting beta-agonist as needed for symptoms.
Step 2—Mild persistent asthma: The preferred controller medication is a low-dose inhaled corticosteroid. Alternatives include sodium cromolyn, nedocromil, or a leukotriene receptor antagonist.
Step 3—Moderate persistent asthma: The preferred controller medication is either a low-dose inhaled corticosteroid plus a long-acting beta-agonist (combination medication is the preferred choice to improve adherence) or an inhaled medium-dose corticosteroid. Alternatives include an inhaled low-dose corticosteroid plus either a leukotriene receptor antagonist, theophylline, or zileuton (Zyflo®).
Step 4—Moderate to severe persistent asthma: The preferred controller medication is an inhaled medium-dose corticosteroid plus a leukotriene receptor antagonist (combination therapy). Alternatives include an inhaled medium-dose corticosteroid plus either a leukotriene receptor antagonist, theophylline, or zileuton.
Step 5—Severe persistent asthma: The preferred controller medication is an inhaled high-dose corticosteroid plus a leukotriene receptor antagonist. Consider omalizumab for patients who have allergies.
Step 6—Severe persistent asthma: The preferred controller medication is a high-dose inhaled corticosteroid plus a leukotriene receptor antagonist plus an oral corticosteroid. Consider omalizumab for patients who have allergies.
For more on the treatment of asthma, read here.
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Cite this: Zab Mosenifar. Fast Five Quiz: How Much Do You Know About Asthma? - Medscape - Jun 04, 2019.
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