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.
Medscape © 2021 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Zab Mosenifar. Fast Five Quiz: Challenges of Severe Asthma - Medscape - Feb 25, 2021.