Fast Five Quiz: Challenges of Severe Asthma

Zab Mosenifar, MD

Disclosures

February 25, 2021

The pharmacologic treatment of asthma is based on stepwise therapy. According to the NAEPP asthma management guidelines, which were reviewed and updated in 2020, the preferred controller medication for severe asthma is a high-dose ICS plus LABA. If the frequency and severity of the patient's symptoms deteriorate or are not improved, the guidelines recommend adding an oral corticosteroid.

The steps outlined in the guidelines for less severe forms of asthma include:

Step 1 for intermittent asthma:

  • Controller medication not indicated

  • Reliever medication is a short-acting beta-agonist (SABA) as needed for symptoms

Step 2 for mild persistent asthma:

  • Preferred controller medication is a low-dose inhaled corticosteroid

  • Alternatives include cromolyn, leukotriene receptor antagonist (LTRA), or theophylline

Step 3 for moderate persistent asthma:

  • Preferred controller medication is either a low-dose inhaled corticosteroid (ICS) plus a LABA (combination medication is the preferred choice to improve compliance) or an inhaled medium-dose corticosteroid

  • Alternatives include a low-dose ICS plus either an LTRA or theophylline

Step 4 for moderate-to-severe persistent asthma:

  • Preferred controller medication is an inhaled medium-dose corticosteroid plus a LABA (combination therapy)

  • Alternatives include an inhaled medium-dose corticosteroid plus either an LTRA or theophylline

Learn more about asthma guidelines.

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